UNDERSTANDING THE CONFUSING WORLD OF MEDICARE

FOR THOSE OF US AT A CERTAIN AGE (OR FOR THOSE WHO ARE RAPIDLY APPROACHING THIS CERTAIN

AGE), THE TERM 'MEDICARE" CAN STRIKE FEAR OR, AT THE VERY LEAST, CONCERNS AND QUESTIONS.

WHAT ARE MY CHOICES?

WHICH CHOICE IS BEST FOR ME?

HOW ABOUT MY COVERAGE IF I SPEND TIME ABROAD?

BUT HOW CAN I MAXIMIZE MY MEDICARE BENEFITS?

WITH THE COST OF PRIVATE HEALTH INSURANCE PREMIUMS ON A STEADY RISE, MOST OF US LOOK

FORWARD TO BECOMING ELIGIBLE FOR MEDICARE.  TODAY, LET'S START AT THE BEGINNING AND TAKE A

LOOK AT A 30,000 FOOT OVERVIEW OF MEDICARE CHOICES WITH A GOAL OF HELPING TO DE-MISTIFY THE

WORLD OF MEDICARE!

ORIGINAL MEDICARE OR STRAIGHT MEDICARE, IN IT'S MOST BASIC FORM INCLUDES MEDICARE PART A AND

MEDICARE PART B.

PART A COVERS INTPATIENT SERVICES SUCH AS DOCTOR SERVICES, SKILLED NURSING CARE, HOSPICE AND

SOME HOME HEALTH CARE.

PART B COVERS OUTPATIENT SERVICES SUCH AS DOCTOR SERVICES, .

ORIGINAL MEDICARE BENEFITS ARE SUBJECT TO AN ANNUAL DEDUCTIBLE AS WELL AS OTHER COST

SHARING. 

MEDICARE PART B PREMIUMS ARE TYPICALLY DEDUCTED FROM YOUR SOCIAL SECURITY BENEFIT AND THE

AMOUNT VARIES DEPENDING ON INCOME.  IF YOU ARE NOT COLLECTING SOCIAL SECURITY YOU WILL HAVE

TO PAY THE PART B PREMIUM DIRECTLY. 

THINGS TO KNOW ABOUT ORIGINAL MEDICARE

1.  MEDICARE IS PORTABLE ONLY IN THE US.  ANY DOCTOR, MEDICAL CLINIC OR HOSPITAL THAT ACCEPTS

    MEDICARE ASSIGNMENT WILL BILL MEDICARE DIRECTLY FOR THEIR SERVICES.

                                                                       HOWEVER

   A.   MEDICARE IS ONLY VALID IN THE US AND US TERRITORIES.  MEDICARE WILL NOT COVER ROUTINE

         MEDICAL CARE INTERNATIONALLY.

   B.   MEDICARE PAYS 80% OF THE COVERED MEDICAL EXPENSES, YOU ARE RESPONSIBLE FOR 20%.

   C.   THERE IS AN ANNUAL DEDUCTIBLE THAT MUST BE SATISFIED.

   D.  MEDICARE LIMITS THE DAYS OF HOSPITAL STAYS AND SKILLED NURSING CARE.

   E.   PRESCRIPTION BENEFITS ARE AVAILABLE THROUGH MEDICARE PART D FOR AN EXTRA PREMIUM AND  

        OTHER COST SHARING BASED ON YOUR MEDICATION.  

                            THINGS TO KNOW ABOUT MEDICARE SUPPLEMENTS (MEDIGAP PLANS)

1.  MEDIGAP PLANS ARE DESIGNED TO "FILL THE GAP" BETWEEN WHAT MEDICARE PAYS AND WHAT YOU

    WILL BE RESPONSIBLE FOR (ANNUAL DEDUCTIBLE AND COINSURANCE)  IN OTHER WORDS, IF YOU ARE

    HOSPITALIZED AND THE TOTAL COVERED BILL IS $100,000, MEDICARE WILL PAY $80,000, AND THE                  MEDIGAP

   PLAN PICKS UP THE DIFFERENCE, USUALLY WITH A SMALLER, PRE-DETERMINED CO-PAYMENT.  MEDIGAP

   PLANS ARE PORTABLE IN THE US, LIKE MEDICARE.

                                                                    HOWEVER 

   A.  MOST MEDIGAP PLANS COVER FOREIGN TRAVEL EMERGENCY SERVICES BUT CAP THE LIFETIME 

          BENEFITSTO $50,OOO.

   B.  FOREIGN TRAVEL EMERGENCY SERVICES ARE PAID ON A REIMBURSEMENT BASIS.

   C.  MEDIGAP PLANS COSTS CAN BE FAIRLY EXPENSIVE.

                                      THINGS TO KNOW ABOUT MEDICARE ADVANTAGE

1.  MEDICARE ADVANTAGE (OR MEDICARE PART C) REPLACES ORIGINAL MEDICARE WITH A PRIVATE

    INSURER, TYPICALLY AS AN HMO (MANAGED CARE) OR PPO PLAN.

2. MEDICARE ADVANTAGE HMO ALLOWS YOU TO ASSIGN A LOCAL PRIMARY CARE PHYSICIAN AS YOUR

   "MEDICAL MANAGER" OR GATEKEEPER TO MEDICAL SERVICES.  YOU CAN CHANGE YOUR PRIMARY CARE

    PHYSICIAN MONTH TO MONTH.

3. BECAUSE MANAGED CARE INCLUDES MANY PATIENT WELLNESS BENEFITS, THE LONG-TERM COST OF

   CARE IS REDUCED, SO THERE ARE MANY BENEFITS INCLUDED SUCH AS PRESCRIPTION BENEFITS, HEARING

   AND DENTAL BENEFITS, WELLNESS PROGRAMS PROVIDED BY YOUR MEDICAL GROUP, ETC.

4. MANY MEDICARE ADVANTAGE PLANS ARE PROVIDED WITH NO ADDITIONAL PREMIUM ABOVE YOUR

   MEDICARE PREMIUM.

5. UNLIKE MOST MEDIGAP PLANS, MEDICARE ADVANTAGE PLANS COVER FOREIGN TRAVEL EMERGENCY

   SERVICES. THERE IS AN ANNUAL LIMIT, TYPICALLY NO LESS THAN TWENTY FIVE THOUSAND DOLLARS.

   THERE IS NO LIFETIME CAP.

                                                                   HOWEVER

   A.  BECAUSE MEDICARE ADVANTAGE PLANS REQUIRE ASSIGNMENT TO A LOCAL PHYSICIAN/MEDICAL

       GROUP, YOU WILL BE REQUIRED TO HAVE ROUTINE DOCTOR VISITS DONE BY YOUR PRIMARY

       PHYSICIAN. THEREFORE THESE PLANS ARE LESS PORTABLE IN THE US.

   B.  ANY COVERED INTERNATIONAL MEDICAL EXPENSE IS PAID ON A REIMBURSEMENT BASIS.

 I SINCERELY HOPE THIS INFORMATION IS HELPFUL.  WE WILL BE EXPLORING DIFFERENT ASPECTS OF MEDICARE IN THE COMING BLOGS.  IN THE MEANTIME, FEEL FREE TO REACH OUT WITH SPECIFIC VEXING QUESTIONS.

COURTESY OF RICK PETERSON

INDEPENDENT INSURANCE BROKER

1-949-677-3864