Medicare

At Health Insurance Plans of Arizona, we are your independent Medicare insurance specialists and we are here to help you, free of charge and without any obligation.

Whether you are just turning 65 and aging in to Medicare, or you are looking for a new plan or supplements that best fit your needs and budget.

As your independent Medicare broker, I can provide you with an overview of the top Medicare insurance supplemental plan carriers so that you and I can work together, compare the carriers and the features in order to help you choose the plan that’s best for you, your budget, and your medical needs. In fact, the most frequently selected plan is free of charge to you!

In addition, we can review the various Medicare benefits and programs that are available, such as low-income programs, prescription drug discounts, low or no premium plans, availability of low doctor co-pays, prescription drug plans and hospitalization plans.

If you’re a new Medicare recipient, you may not be aware of enrollment requirements. As your Medicare agent, I can help to insure that we have you enrolled on time, avoiding any late enrollment penalties. So long as you have your red, white and blue Medicare card (which typically arrives in your mailbox three months prior to your birthday) we can get you enrolled right away! (If you do not receive your card, give me a call, I can help!)

In addition, I will be available to assist you on an ongoing basis, so you’ll always be able to count on me to help you as your needs and wants change over the coming years.

I am here to answer any of your questions or just to chat about your Medicare benefits, so please feel free to give me a call at anytime at 480-288-4310 or email me through the contact page of this website.

The following is mostly based on information found at www.Medicare.gov

Medicare is a health insurance program for:
  • people age 65 or older,
  • people under age 65 with certain disabilities, and
  • people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
Medicare has Part A Hospital Insurance:

Most people don’t pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.

Cost For Medicare Part A:

Most people don’t have to pay a monthly payment, called a premium, for Part A. This is because they or a spouse paid Medicare taxes while working. If a beneficiary doesn’t get premium-free Part A, they may be able to buy it if they (or their spouse) aren’t entitled to Social Security, because they didn’t work or didn’t pay enough Medicare taxes while working, are age 65 or older, or are disabled but no longer get free Part A because they returned to work.

Part B Medical Insurance:

Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors’ services and outpatient care. It also covers some other medical services that Part A doesn’t cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

Prescription Drug Coverage Under Part B:

Most people will pay a monthly premium for this coverage. Starting January 1, 2006, new Medicare prescription drug coverage will be available to everyone with Medicare. Everyone with Medicare can get this coverage that may help lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.

Medicare Part B Cost:

The Medicare Part B premium each month ($99.90 per month in 2012). In some cases, this amount may be higher if the beneficiary didn’t sign up for Part B when they first became eligible.

Caution: If the beneficiary didn’t take Part B when they were first eligible, the cost of Part B will go up 10% for each full 12-month period that they could have had Part B but didn’t sign up for it, except in special cases. They will have to pay this penalty as long as they have Part B.

They also pay a Part B deductible each year before Medicare starts to pay its share. The Part B deductible for 2012 is $140.00. The beneficiary may be able to get help from their state to pay this premium and deductible.

Medicare deductible and premium rates may change every year in January.

Different types of Medicare Advantage Plans:
  • Health Maintenance Organization (HMO) Plans
  • Preferred Provider Organization (PPO) Plans
  • Private Fee-for-Service (PFFS) Plans
  • Special Needs Plans (SNPs)
There are other less common types of Medicare Advantage Plans that may be available:

HMO Point of Service (HMOPOS) Plans: An HMO Plan that may allow you to get some services out-of-network for a higher cost.
Medical Savings Account (MSA) Plans: A plan that combines a high deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year.

How do Medicare Advantage Plans work?

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.

Covered services in Medicare Advantage Plans

Medicare Advantage Plans cover all Medicare services. Most Medicare Advantage Plans also offer extra coverage, like vision, hearing and dental coverage.

Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.

Each Medicare Advantage Plan can charge different out-of-pocket costs and can also have different rules for how you get services, like:

  • Whether you need a referral to see a specialist
  • If you have to go to doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care

These rules can change each year.

Costs for Medicare Advantage Plans

Most Medicare Advantage Plans include prescription drug coverage (Part D). You can join a separate Medicare Prescription Drug Plan with certain types of plans that:

  • Can’t offer drug coverage (like Medicare Medical Savings Account plans)
  • Choose not to offer drug coverage (like some Private Fee-for-Service plans)

If you’re in a Medicare Advantage HMO or PPO, and you join a separate Medicare Prescription Drug Plan, you’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.

Beware of Medicare Fraudsters!

When you join a Medicare Advantage Plan, you’ll have to give your Medicare number and the date your Part A and/or Part B coverage started. This information is on your Medicare card. Don’t give personal information to plan callers

Medicare plans aren’t allowed to call you to enroll you in a plan, unless you specifically ask to be called. Also, plans should never ask you for financial information, including credit card or bank account numbers, over the phone.

No one should call you without your permission, or come to your home uninvited to sell Medicare products. Call 1-800-MEDICARE to report a plan that does this.

Medicare Part D Option:

Unless you have other drug coverage, you should carefully consider Medicare prescription drug coverage (Part D). You may also want to consider a Medicare Supplement Insurance (Medigap) policy. Remember, you may only be able to switch at certain times of the year.

If you have other coverage:

Talk to your employer, union, or other benefits administrator about their rules before you join a Medicare Advantage Plan. In some cases, joining a Medicare Advantage Plan might cause you to lose employer or union coverage. If you lose coverage for yourself, you may also lose coverage for your spouse and dependents.

In other cases, if you join a Medicare Advantage Plan, you may still be able to use your employer or union coverage along with the plan you join. Remember, if you drop your employer or union coverage, you may not be able to get it back.

How to get drug coverage:

Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to get Medicare drug coverage when you’re first eligible, you’ll likely pay a late enrollment penalty unless one of these applies:

  • You have other creditable prescription drug coverage
  • You get Extra Help

To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.

2 ways to get drug coverage:

Medicare Prescription Drug Plan (Part D). These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.

Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage. You get all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage, and prescription drug coverage (Part D), through these plans.

Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.

Your Medicare Advantage Plan (Part C) will disenroll you and you’ll go back to Original Medicare if both of these apply:

  • Your Medicare Advantage Plan includes prescription drug coverage.
  • You join a Medicare Prescription Drug Plan (Part D).
When can I buy Medigap?

Buy a policy when you’re first eligible! The best time to buy a Medigap policy is during your 6-month Medigap open enrollment period. During that time you can buy any Medigap policy sold in your state, even if you have health problems. This period automatically starts the month you’re 65 and enrolled in Medicare Part B (Medical Insurance). After this enrollment period, you may not be able to buy a Medigap policy. If you’re able to buy one, it may cost more.
During open enrollment

Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy. However, even if you have health problems, during your Medigap open enrollment period you can buy any policy the company sells for the same price as people with good health.

If you apply for Medigap coverage after your open enrollment period, there’s no guarantee that an insurance company will sell you a Medigap policy if you don’t meet the medical underwriting requirements. Ask your broker at Health Insurance Plans of Arizona about your specific coverage needs.

Medigap & Medicare Advantage Plans:

Medigap policies can’t work with Medicare Advantage Plans. If you have a Medigap policy and join a Medicare Advantage Plan (Part C), you may want to drop your Medigap policy. Your Medigap policy can’t be used to pay your Medicare Advantage Plan copayments, deductibles, and premiums.

 

 

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