Medicare Enrollment 2013 Opens Soon!
Summary: Open enrollment for Medicare Enrollment 2013 begins October 15, 2013 and extends through December 7, 2013. Do you know what the c0verage and costs are? Do you understand Medigap policies? Is Medicare part of the health insurance marketplaces?
According the official Medicare website, Medicare is “the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).”
Medicare is broken down into 4 parts:
Coverage for each part Medicare varies depending upon the purpose of each section.
Durable Medical Equipment
2nd Opinion before surgery
Limited outpatient prescription drugs
Combination of A and B with the exception of hospice
May have additional coverages such as dental and vision
Each Medicare drug plan has its own coverages known as formulary
Cost varies by each part of Medicare depending upon individual purpose of each section.
Up to $441 per month
Generally free if you are over 65 if:
You are receiving retirement from Social Security
You are eligible for Social Security but haven’t filed yet
You or your spouse had Medicare-covered government employment
$104.90 per month premium (depending upon whether single or family and based upon income level for 2011
$147 annual deductible
Out of pocket expenses are determined by:
Whether the plan charges a deductible
Whether the plan charges a monthly premium
Type and frequency of services needed
How much you pay per visit or service
Plan rules such as in our out of network
Whether additional benefits are needed
Costs are composed of:
Copayment or coinsurance
Costs in the coverage gap
Costs if you get extra help
Supplemental Insurance otherwise know as Medigap insurance
In addition to the 4 basic parts of Medicare, there is also something called Medigap insurance. Medigap policies fill in the gaps and help pay for some of the costs not paid by Medicare such as: coinsurance, deductibles, and copayments.
8 things to know about Medigap policies & Medicare Enrollment 2013
You must have Medicare Part A and Part B.
Can’t have both a Medicare Advantage and Medigap insurance concurrently.
Medigap insurance is private insurance and premiums are in addition to Part A and B.
Medigap policies are individual policies; therefore one policy cannot cover an individual and a spouse – 2 separate policies would be required.
You can buy a Medigap policy from any insurance company that’s licensed in your state to sell one.
Any standardized Medigap policy is guaranteed renewable which means you cannot be cancelled for health reasons.
Policies sold after January 1, 2006 are not allowed to included prescription drug coverage.
If you have a Medicare Medical Savings Account ( MSA), you are not allowed to also have a Medigap policy.
Health Insurance Marketplace and Medicare
Currently Medicare is completely separate from the Health Insurance Marketplaces which will become effective in 2014.
5 things to know about the Affordable Care Act and Medicare:
Your Medicare coverage is protected.
You get more preventative services, for less.
You can save money on brand-name drugs.
Your doctor gets more support.
The ACA ensures the protection of Medicare for years to come.
About BHM Healthcare Solutions
BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including managed care consulting, strategic planning and organizational analysis, accreditation consulting, healthcare financial analysis, physician advisor/peer review, and organizational development. Remember, Medicare Enrollment 2013 is coming soon!
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