2009 MEDICARE BENIFITS OVERVIEW
Medicare Part A and Part B
Let us start with the first two parts: Part A covers hospital benefits and Part B covers all other medical care. Both combined cover around 75 percent of all your medical cost minus prescriptions outside the hospital. Part A helps pay for services in Medicare-certified hospitals, skilled nursing facilities, hospice, and some home healthcare agencies. Most people do not have to pay an enrollment fee for Part A if they meet Medicare’s qualifications.
Even if you qualify for Part A without paying a premium, you must pay for Part B if you want it–which you will. There is a monthly premium associated with Part B coverage. Part B covers care outside of hospitalization such as physician/surgeon services, outpatient services, ambulances, physical therapy, mental health, and some medical supplies and equipment. Part B does not cover routine checkups, hearing aids, or other ?extras.? The cost for Part B for the 2009 year is currently a minimum of $96.40 per month. If and when you receive your social security check, the premium will be debited from your check. If you do not yet receive your social security check, you will be requested to pay the stated amount from your own personal account.
Medicare Part A:
- Covers only in the hospital.
- Covers up to around 75 percent of medical costs.
- No extra premium.
- You must have paid up to 40 quarters via payroll taxes.
Medicare Part B:
- Covers outside the hospital.
- Covers up to around 75 percent of medical costs.
- The 2009 minimum premium is $96.40 a month.
- Does not cover prescriptions.
- You must have Medicare Part A to get Medicare Part B.
Medicare Part C
Since Medicare Part A and Part B roughly pay for around 75 percent of all your medical cost, you are now at a fork in the road. You may stay only with Part A and Part B and pay the rest on your own, or you may have a “gap plan” (also called Part C) to cover the rest. Part C will cover the rest of what Medicare Part A and Part B does not cover. Please note that Medicare Part C does not cover prescriptions. One option under Part C is to go the “traditional” method using co-pays and deductibles, which is also called Medicare Managed Care plan or Senior Care plans or Medicare Advantage plans
The other option under Medicare Part C is to go with the Medigap plan, which pays 100 percent of your medical cost without any co-pays and deductibles. These plans are usually called Medicare Supplement Plans. These plans are going to have higher premiums, but they will cover all parts of your medical care, which helps lower your out-of-pocket medical expenses all the way to zero if you so desire.
At this point you can stop and pay the rest of your medical costs out of your own pocket that Medicare Part A and Part B does not cover. However, if you want the rest to be covered by insurance, you may add Medicare Part C.
Medicare Part C:
- There are two options and both options do not cover prescriptions.
- Option 1: Go with a co-pay and deductible plan through a local insurance company in your state. These plans are called Medicare Advantage Plans and also Medicare Managed Care Plans. These plans run around zero dollars up to $50 depending on the coverage type you are requesting.
- Option 2: Go with a plan that covers most to everything out-of- pocket for medical issues. This option is what Good Neighbor Insurance can help you out with. Please click here to fill out our Medicare form.
Now let us continue with the rest of Medicare:
Good Neighbor Insurance will be able to provide, in most states, a Medical Supplement Plan that will fit your needs. In the Medicare Supplement Plans, you will have an array of options from Plan C to Plan K, with Plan F being the ?best bang for your buck.? Please click on this form and fill out the needed information so we may provide you with a couple of Medicare Supplement Plan s that will fit your needs.
Medicare Part D
Part D is the area regarding your prescriptions while outside the hospital. Below is information that will give you more insight on how this government program works. We would suggest the most cost-effective and beneficial way of finding the best Part D plan for you is to go to your pharmacy where you get your prescriptions and check with them what plans they have for you.
Below is more information on Part D, as well as a graph that shows your out-of-pocket expenses:
- Part D program began January 1, 2006.
- Coverage of Medicare Part D benefits is provided by private companies.
- Medicare pays a share of the program costs.
- Individuals entitled to Part A and/or enrolled under Part B are eligible for Part D.
- Part D coverage is provided through network pharmacies in the Part D service area.
- For 2009, the standard benefit requires the beneficiary to pay:
- $295 deductible
- 25 percent of costs between $295 and $2,700 = $601.25
- 100 percent of the next $3,453.75 in drug costs (the “coverage gap”), then
- After the beneficiary has paid $4,350 out-of-pocket, catastrophic coverage begins.
** On any future prescriptions, the beneficiary pays either a co-pay of $2.40 for generic drugs or $6.00 for brand name drugs or a co-insurance of 5 percent, whichever is greater.