Q. What are the changes to Medicare in 2010?
A. Medicare consists of three parts: hospital insurance (part A), health insurance (part B), and drug insurance (RX) (part D). Part A The deductible amount for 2010 is $ 1,100 for a hospital stay of 1–60 days, $ 275 per day for 61–90 days, and $ 550 for a 91–150 day hospital stay (reserve days of life). After 150 days you pay all expenses for the hospital. Part A also includes qualified nurses and some home health care, but not long-term care. Qualified medical institutions are subject to joint insurance in the amount of US $ 137.50 for days 21-100. Part B covers medical services provided by Medicare, outpatient hospital services, and some home health services and durable medical equipment. You pay 20% of the Medicare-approved amount after you deduct $ 155.
Part D covers both short-term and long-term prescription needs not provided by the hospital, coverage of both brand name and generic drugs, and may differ dramatically from one company to another. Part D is not deductible from your social security check.
Q. Can you explain the difference between a franchise, a joint payment and out of pocket.
A. The deductible amount is the amount you have to pay for medical care before Medicare starts paying. These amounts are subject to change every year. Co-payment is a partial cost that you spend on a visit to the doctor. They may be zero or more. These are out of pocket, which are expenses that you have to pay yourself, because they are not covered by Medicare.
Q. What are the differences in HMO, PPO, PFFS, SNP and MSA plans?
A. Health Care Organizations (HMO). Like the private sector, a HMO is a group of doctors, hospitals, and other health care providers who agree to provide medical care to Medicare recipients for a certain amount of Medicare money each month. You get your help from the supplier in the plan.
Preferred Provider Organization (PPO). Doctors, hospitals, and providers who belong to the network and with most PPO plans, you can use doctors, hospitals, and providers outside the network for an additional fee.
Private service charge (PFFS). They are sometimes called regional PFFS, because the doctor or hospital accepts payments from the insurance plan rather than Medicare. The insurance plan decides how much it will pay and what you pay for the services you provide. You can pay more or less for benefits covered by Medicare.
Special Needs Plan (SNP) is a type of plan for people with chronic diseases or conditions with special needs.
Medical Savings Plans (MSA) are a type of savings plan for those people who often do not go to the doctor, but need a savings plan to pay part of the cost of franchises and co-payments.
Q. My doctor takes Blue Cross, but does not take Medicare Advantage Blue Cross. What does it mean?
A. Medicare Advantage Plans are a hybrid of coverage offered by an insurance company. When you are eligible for Medicare at age 65, you choose Part C - Medical Insurance offered by the company. You still pay your insurance premiums from your Social Security check for Part B, but the government pays the insurance company to manage benefits. These Medicare Advantage plans seem to have many benefits and include drug coverage (Part D). Medicare Advantage plans are the best of both worlds, but they have some drawbacks. If your doctor is not a Medicare Advantage plan doctor, you will pay additional costs to see him / her, but with most plans you may see another doctor (usually not available in the HMO plan). You will be subject to separate franchises and separate co-payments and often need a referral for approval before you can get help from a specialist. If you do not receive a referral, the plan may not pay for your help.
Q. Since Medicare Advantage provides all Medicare medical services through this plan, what if I don’t like it? I heard that the payments of doctors will be reduced, and the company with which I will register may cease to insure them. What protection do I have?
A. Since Medicare is a plan provided by the government for those over 65, you have many coverage options. From November 15 to December 31, you can switch from one version of Medicare to another — you can register at any time with either Medicare Advantage or Part D. This is called the annual registration period. (AEP) Your new coverage will start on January 1st. From January 1 to March 31, Medicare members can make one plan change the same. For example, you can switch to another MA plan. A member MAY NOT change the coverage of Part D during this time unless they have a plan that they leave. This is called the Open Enrollment Period (OEP). During the special registration period (SEP), participants must register within 63 days after the special event. This happens if you go beyond the service area, go to a long-term institution or leave it, lose confidence in the prescription of a drug, return to the US from another country, or get help from the state in which you live, free coverage with your employer or union either voluntarily or unwittingly.
Q. What other benefits do I get with Medicare Advantage?
A. You can get additional benefits by choosing a Medicare Advantage Plan. These may include a program of vision, hearing, teeth, and / or health and wellness, including membership in a specific gym. Since you do not need to buy a Medigap or Medicare Supplement policy, the premium is complemented by the government and is cheaper than the traditional supplemental plan.
Q. I heard that there are many gaps in part D (medicine) coverage, and I take 5 prescriptions per day. How to get most of my medications?
A. Each insurance company offering part D coverage has a written list of drugs. These include generic and branded drugs. (Check the websites or ask your agent to print a form book about drugs.) Your plan may have several levels, and the amount of your co-payment depends on what your computer is listed for. Not all brands will be covered, and it can be very expensive if you have a high surcharge or it is not specified. Always ask your doctor if medications are prescribed as general. Do not forget to ask your doctor if you can divide the high-dose version of the prescribed medications as
they often have the same price as the low-dose version, or go to http://www.medicare.gov/MPDPF/Public/Include/DataSection/Questions/MPDPFIntro.asp?version=default&browser=IE%7C7% 7CWinXP & language = English & defaultstatus = 0 & pagelist = Home & ViewType = Public & PDPYear = 2010 & MAPDYear = 2010 & MPDPF% 5FMPPF% 5FIntegrate = N to compare medication plans in California.
Q. I like what I see - a policy issued by a leading insurance company that did not cost me the same as Medigap or Medicare Supplement. Why should I buy a Medicare application, not a Medicare Advantage policy?
A. This is a good question. If you can afford individual Medicare premiums with a separate Part D, you should. You can choose your doctor while this doctor accepts Medicare patients. Today, many plans are a hybrid and some cost of the ZERO monthly premium and include RX plans and PPOs so that people have the freedom of PPO. As the age of the elderly, options and benefits become very important, and we are here to help you decide which plan is best for you. Be sure to choose Medicare.
