Medicare is going to be changing under the new health laws. It is important to keep up with these changes. To further complicate things, Congress has introduced bills to alter the changes under the new Obama health care laws. Right now, this is where we are:
Medicare A: covers hospitalization including some nursing home care such as rehab, this is a free benefit if you have enough Social Security quarters. Some individuals wind up paying for this. You must sign up for Part A in order to have Medicare coverage.
Medicare B: covers doctor visits and out of hospital care – you have to pay for this – you can refuse this coverage, but it is usually cost effective to take. If you refuse this benefit when first offered, you will pay a penalty if you elect it later on. Most people are paying $96.40 monthly for this benefit. Even if you select C, you still need to pay for B.
Medicare C: This is the Senior Advantage programs that include HMOs or PPOs – you elect these and will have to pay for this. Most Senior Advantage Plans include A,B,C, and D at this time. You do not need to sign up for Medicare C. In general, Senior Advantage Programs require copays and deductibles. Medigap polices often have no copays and/or deductibles, but you have to carefully examine your plan options.
Medicare D: This is drug coverage which you have to elect. It is about $30 a month if you buy it separately. This is usually a good deal, but you don’t have to buy it.
When you turn 65, you have a seven month window to sign up for benefits. If you fail to do this, it will cost you more if you don’t sign up during the initial enrollment period. If you have you insurance through an employer, say the federal government, you will have to sign up during the company’s open enrollment period. Beware that disability and certain medical diseases will allow you to sign up for these benefits before 65, and some folks can be eligible at 62 if they retire early.
If you have or sign up for a Senior Advantage Plan you do not need and cannot be sold a Medicare Gap Plan. A Medicare Gap Plan will cover some of the gaps in your A, B, and D coverage. It will cover only the gaps listed in the plan. If you buy a Senior Advantage Plan and have Medigap coverage, the Medigap coverage will not pay for any of your expenses. Medicare will not pay twice for the same care. You cannot have both types of coverage.
You can change your Senior Advantage Plan from between November 15 and December 31 of each year. You can sometimes change it from January 1 to March 31 of each year. Generally, once you change plans you must stay signed up for a whole calendar year. These dates apply if you don’t go through an employer’s plan. If certain things change, such as you move out of your HMO’s area, or your plan goes out of business, you can change at other times of the year. Your can look these up at the site www.medicare.gov.
If you don’t sign up for a Senior Advantage Plan, you can sign up for drug coverage, Part D, separately. The open period for these plans is November 15 to December 31 only. Again, if you select a plan expect to keep it for a whole calendar year.
Medigap polices no longer include any drug benefit. You must purchase this benefit under Part D separately. Medigap polices cover the fees that Medicare does not pay. Medigap policies come in types A through L. Each letter covers different aspects of the Medicare gap.
A – covers Part A hospital copays for hospital day 60 and beyond. Covers some Part B copays and the cost of the first three pints of blood and pays $120 towards preventive care.
B – covers all in A and pays $992 toward your hospital copay under Medicare A which is $1050 per stay.
C – covers all in B and includes a copay for nursing homes after 20 days and pays for part of emergency foreign care plus a benefit for doctor copays and outpatient care. Fairly comprehensive plan.
D – covers all in C except doctor and outpatient care copays and adds an at home recovery cost benefit.
E – covers all in D except at home recovery cost benefit.
F – covers everything in C and includes a benefit that pays for excessive copays.
G – covers everything in C and 80% of excessive copays and a copay for at home recovery costs.
H – covers everything in C except doctor and outpatient care copays.
I – covers everything in C except doctor and outpatient care copays and includes benefit that pays for excessive copays and for copays for at home recovery.
J – covers everything in I and includes doctor and outpatient care copays. Fairly comprehensive plan.
K – covers 50% of everything in Part B, except that it pays 100% of hospital copays and includes a preventive care option and will pay your monthly medicare fees after you pay $4140.
L – is similar to K, except that it covers 75% of everything in Part B and will pay your monthly medicare fees after you pay $2070. Comprehensive plan.
You can search for Medigap policies in your area through the www.medicare.gov website. An example of pricing which uses my area of Northern California is below.
F policies run from $20 to $67 monthly
K policies run from $53 to $89 monthly
A policies run from $59 to $484 monthly
L policies run from $96 to $466 monthly
B policies run from $99 to $419 monthly
D policies run from $102 to $316 monthly
G policies run from $$106 to $391 monthly
C policies run from $115 to $384 monthly
H, I or E does not seem to be offered in my state, but this gives you an idea of pricing on Medigap Plans.