Medicare can be a complicated sea of information to wade through.
At Tidewater Insurance Solutions, we offer Medicare Supplement and Medicap Plans, Medicare Advantage Plans and Medicare Part D Plans (Drug Plans). We will sit down with you at your home or office to discuss your needs and desires. We are here to help you find the absolute best solution to fit your needs at no cost to you.
We’ve gathered some common questions and answers below for your convenience. Or, just give us a call or send us an email and we will respond promptly.
What is “Original Medicare?”
It is Part A and Part B Medicare coverage provided by the federal government.
What is Part A?
Part A helps with hospital costs, skilled nursing services and hospice.
When can I join Part A?
Eligibility begins when a person turns 65. The “initial enrollment period” lasts seven months and begins three months before the beneficiary turns 65.
How do I sign up?
When you receive Social Security benefits, you are automatically enrolled in parts A and B. You may sign up for Part A and B at your local Social Security office if you’re not currently receiving Social Security benefits or sign up online at www.socialsecurity.gov
Can Part A refuse to cover me or delay coverage?
Assuming you are eligible for Medicare, you can’t be refused Part A because of your medical history or a pre-existing illness.
How does renewal work?
Part A coverage renews automatically from year to year. You are not required to do anything.
What does Part A cost?
Part A is free to you and your spouse if you’ve made payroll contributions to Social Security for at least 10 years (40 quarters).
Is there a Part A deductible?
Before Part A pays a share of your costs, you must first pay a deductible. In 2017, the deductible is $1,316. The deductible is for each hospital stay and subject to certain limits.
Are there insurance co-payments in Part A?
You are subject to a co-payment after you have stayed a certain number of days in the hospital. The first 60 days are covered. You pay $329 per day for hospital days 61 through 90, and $658 per day for days 91 through 150. In a skilled nursing facility (not custodial care,) the first 20 days are fully covered. However, you’ll pay $164.50 per day for days 21 through 100.
What is Part B?
Part B helps with the costs of doctor visits and other medical services that do not require an inpatient hospital stay.
What is the cost of Part B?
Part B premium is $134 a month (based on annual income) and can be billed directly. However, many have their monthly premium withdrawn from their monthly social security check.
Is there a Part B deductible?
Yes. Before Part B pays a share of your costs, you must first pay a deductible of $183 in 2017.
Are there insurance co-payments in Part B?
After the deductible has been met, Medicare Part B pays 80% of the Medicare-approved amounts and the beneficiary is responsible for the remaining 20%. If a doctor does not accept Medicare assignment, their costs are often higher which means you pay an excess charge of 15%.
What are the Election Periods?
Initial Enrollment: 7-month period beginning 3 months before the month you turn 65, including the month you turn 65, and ending 3 months after the month you turn 65.
Annual Election Period: October 15-December 7 each year
- The period you can enroll or change your Medicare Advantage (MA) plan.
- You may also switch to Original Medicare and a Prescription Drug Plan (PDP).
- New coverage begins January 1st of each year.
- You can enroll in a MA plan with prescription drug coverage included, but not a stand-alone MA plan at the same time as a stand-alone Part D plan.
Special Enrollment Period: (Most common examples)
- People covered under their employer’s health plans who retire after age 65, can enroll with no penalty during the three months before their Part B takes effect or eight months after the group health plan coverage ends.
- Or, when you qualify for Medicare’s Extra Help, or both Medicaid and Medicare.
- Or, if you have moved outside the plan’s service area.
What’s not covered by Original Medicare?
- Custodial Care (help with bathing, toileting, dressing, eating, walking, etc.)
- Some routine physical exams Routine hearing tests
- Most care while traveling outside the U.S.
- Extended long term care
- Many diabetic supplies
- Most chiropractic services
- Routine foot care
- Acupuncture
What is Medicare Part C?
Part C is a plan offered by private insurance companies that combine coverage for Medicare Parts A & B. Beneficiaries must be enrolled in Parts A & B. Medicare pays a monthly fee to private companies to provide insurance that meets the minimum Medicare coverage expectations. Private companies coordinate a member’s care through a network of doctors and hospitals. Depending on the plan design, coverage may be through a local, regional or national medical network. These plans may also include Part D – Prescription Drug coverage.
What is the cost of Part C?
Costs may vary from no monthly premium costs to several hundred dollars a month depending on the coverage. (Regardless of Part C’s premium, the beneficiary is responsible for continuing to pay Part B’s monthly premium.)
What is Medicare Part D – Prescription Drug Plan (PDP)?
Part D – Prescription Drug Plans – are insurance policies purchased from private companies. They help pay for the prescription drugs. A beneficiary may buy a separate policy or purchase a Medicare Advantage plan that includes drug coverage. The federal government sets guidelines for establishing minimum standards of benefits.
What pharmacies may I use?
Each PDP – Prescription Drug Plan – decides which pharmacies members may use. Some pharmacy networks are local and others have a national pharmacy network. Depending on the PDP, mail order services may also be available.
What are the prescription coverage limits?
Part D coverage involves significant cost sharing until you have spent $4,700 out of your pocket in a single year. At that point, you are eligible for what Part D calls “catastrophic coverage.” Going forward the beneficiary pays a small co-insurance or co-payment for a covered drug and the plan pays the rest for the remainder of the year.
Additional Resources
Medicare
1-800-MEDICARE (1-800-633-4227)
TTY 1-877-486-204924 hours/day, 7 days/week
www.medicare.gov
Social Security Administration
1-800-772-1213
TTY 1-800-325-0778
www.ssa.gov
Administration on Aging
Eldercare Locator
1-800-677-1116
www.eldercare.gov
State Health Insurance Assistance Program (SHIP)
Call us at (757) 636-6563 or send us an email if you have any questions, or for your free consultation. We are here to help.