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Explanation of What is Medicare:

U.S. government health insurance program for seniors 65+ and approved disabled individuals <65 and those with end-stage renal failure.  Everyone is notified by Medicare when they are 65 and have a specific timeframe (set by Medicare) to respond.   If you meet certain requirements, you can delay Medicare but you still have to respond to their notification otherwise face penalty fees that will be added to your monthly Medicare premiums.  If in doubt ask?  Supplement insurance may be purchased all year but Advantage plans (Part C) and drug plans (Part D) can only be purchased during open enrollment October 15 thru December 7.  There are exceptions under certain circumstances.  The most important exception is that you must enroll in Part C (if you want an Advantage plan) and your drug plan (Part D) if you choose a supplement plan within six months of your 65th birthday you cannot wait until the official enrollment period or face penalty fees. There are four parts to Medicare:

Medicare Part A:  Everyone receives Medicare Part A at age 65.  Part A is your basic coverage for hospital, it pays 80% of your hospital stay, after a deductible of $1,260 (2015) and covers 1-60 days and there is no premium.

Medicare Part B:  This is coverage for your Dr.  and the premium varies from $104 a month or more depending on your income and usually comes out of your Social Security check or for those not taking Social Security they may pay a premium directly to the U.S. government.  There is an annual deduction of $147 (2015).  Part B pays 80% of the total approved charge.

Medicare Part C:  Medicare has sub-contracted Part C to private insurance companies called Advantage Plans.  The government oversees these plans and decides which insurance companies can sell in which zip code.  You are officially a client of the insurance company and have to use their insurance card and cannot use your Medicare card.  You still have to pay your Part B premiums but these are sent to the insurance company managing your Advantage Plan and you may also have an additional premium to pay the insurance company for your Advantage Plan.  Advantage Plans are either HMO’s which are usually free or PPO’s that usually have an additional premium.  Advantage Plans include your drug plan Medicare Part D.

Medicare Part D:  You have to have a separate drug plan (Part D) if you are on Medicare and have a Medicare supplement plan and do not have an Advantage Medicare Plan (Part C) which includes your drug plan.  You need to purchase a Medicare Part D plan from an independent insurance company but if you do not purchase a plan when you are first on Medicare you will incur penalty fees if you sign up later

Secondary screen titled:   Medicare Supplement Insurance

Supplement insurance is secondary insurance to your primary government insurance (Medicare Parts A and B) offered by private insurance companies.  There are a number of Medicare supplement plans A-N but the most important popular are:

Plan F:  We call it the Cadillac of plans it usually is the most expensive and pays 20% of the Medicare approved medical charges (Medicare Part A and Part B pays 80% of approved medical charges), as well as the Part A and B deductibles.   You may be refused coverage (usually due to health) except during your guaranteed periods, when you are 65 (the month of your birthday and six months after) and when you first leave your employer insurance when you are 65 and older.  Plan F is the only plan guaranteed issue when you leave your employer insurance if you missed your guaranteed period when you were 65.   

Plan G:  We call it the BMW of plans it pays the same 20% as Plan F but does not pay the Part B deductible.  You can be refused coverage except during your guaranteed period when you are first 65.

Plan N:  We call it the Kia of plans it pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that do not result in an inpatient admission.  You can be refused except during your guarantee period when you first turn 65.

HDF (high-deductible F):  We call it the Pinto of plans (not in all states).  You must pay for all Medicare approved costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,140 (2015) before you policy pays anything.  After you meet your annual deductible the plan pays everything like Plan F.

Supplement insurance is sold by private insurance companies but regulated and standardized by Medicare, the states of Massachusetts, Minnesota and Wisconsin have different rules.  Insurance companies can offer additional benefits such as cover medical expenses when you are traveling out of the country.  It is important to read your policy because all Insurance plans have a lifetime plan limit.

The plans listed above will cover foreign travel medical emergencies up to 80%.  Premiums vary and are set by the insurance companies and take into account your age and health (they look at your prescription drug list)  and zip code  (except during your guaranteed period, the month of your 65th birthday and six months after when you cannot be refused coverage because of your health and they cannot ask any health questions). 

If you have Medicare supplement insurance you probably will need a separate drug plan, Medicare Part D.  You can only enroll in a Drug Plan (Medicare Part D) during open enrollment for Medicare October 15 thru December 7 except when you first go on Medicare.    

Would you like information on Medicare Supplement Insurance Plans: