Medicare Glossary

The Must-Read Medicare Glossary

*Repost* http://www.aarp.org/health/medicare-insurance/info-2017/medicare-glossary-reference.html

A reference tool for some of the most commonly used Medicare terms

by Dena Bunis, AARP Bulletin, October 2017|Comments: 0

There are key terms you should know when researching Medicare options.

Medicare: The federal program that helps people over 65 and some people with disabilities pay for their health care. It is structured as an insurance program with several “parts.” Each covers a different type of cost.

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Part A: Covers hospital stays, selected costs of continuing care after a hospital stay, some home health services and hospice.

Part B: Covers doctor visits and services, preventive care, lab tests and screenings, medical equipment and supplies, and some home health care.

Part C: Allows private health insurance companies to provide Medicare benefits. Known as Medicare Advantage plans, they are often HMOs or PPOs offering comprehensive health coverage that includes the services covered by parts A and B and sometimes more. Most also cover prescription drugs (Part D).

Part D: Covers outpatient prescription drug costs.

Supplemental Insurance, also known as Medigap: This is optional private insurance that Medicare recipients can buy to pay for out-of-pocket expenses (such as coinsurance costs) that traditional Medicare doesn’t cover. 

Coinsurance: The percentage of the cost that you pay for a medical service or equipment. For example, for many Part B services, Medicare pays 80 percent of the cost; your coinsurance in those cases is 20 percent.

Copay: A specific dollar amount that you pay as your share of the cost of a medical service or equipment. For example, in a Medicare Advantage plan, you might have a $25 copay for a doctor visit; under Part D, you might have $10 copay for a particular prescription each time you get a refill.

Coverage gap: Also called the doughnut hole, this kicks in when you and your prescription drug plan costs reach a coverage limit that the government sets each year — $3,750 for 2018. After that, you pay a larger share of your prescription drug costs until your out-of-pocket costs reach a government-set threshold — $5,000 in 2018. After that, the government picks up most of the tab for your drugs. Under the Affordable Care Act, this coverage gap will be eliminated in 2020.

Deductible: The amount you must pay before insurance pays anything. For example, the Part B deductible in 2017 was $183; that means you must pay for the first $183 in expenses that fall under Part B before it will begin covering costs. 

Also of Interest

• READ: Medicare Resource Center
• WHERE AARP STANDS: AARP CEO: We'll fight for Medicare
• READ: Navigating the Medicare maze
• TELL US: What are your concerns about Medicare?

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What Is Medicare Supplement Insurance?

                      *repost: https://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html               What's Medicare Supplement Insurance (Medigap)?

A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the health care costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles.

Some Medigap policies also offer coverage for services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.

A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.

8 things to know about Medigap policies 

1. You must have Medicare Part A and Part B.
2. If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can leave the Medicare Advantage Plan before your Medigap policy begins.
3. You pay the private insurance company a monthly premium for your Medigap policy in addition to the monthly Part B premium that you pay to Medicare.
4. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.
5. You can buy a Medigap policy from any insurance company that's licensed in your state to sell one.
6. Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can't cancel your Medigap policy as long as you pay the premium.
7. Some Medigap policies sold in the past cover prescription drugs, but Medigap policies sold after January 1, 2006 aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
8. It's illegal for anyone to sell you a Medigap policy if you have a Medicare Medical Savings Account (MSA) Plan.

Medigap policies don't cover everything

Medigap policies generally don't cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

Insurance plans that aren't Medigap

Some types of insurance aren't Medigap plans, they include:

• Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan)
• Medicare Prescription Drug Plans
• Medicaid
• Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)
• TRICARE
• Veterans' benefits
• Long-term care insurance policies
• Indian Health Service, Tribal, and Urban Indian Health plans

Dropping your entire Medigap policy (not just the drug coverage) 

If you decide to drop your entire Medigap policy, you need to be careful about the timing. For example, you may want a completely different Medigap policy—not just your old Medigap policy without the prescription drug coverage. Or you might decide to switch to a Medicare Advantage Plan that offers prescription drug coverage.

You have to pay a late enrollment penalty when you join a new Medicare drug plan if:

• You drop your entire Medigap policy and the drug coverage wasn't creditable prescription drug coverage, or
• You go 63 days or more in a row before your new Medicare drug coverage begins

To learn more about the costs of MediGap: https://www.medicare.gov/supplement-other-insurance/medigap/costs/medigap-plan-costs.html

Medicare Supplement Insurance Policy Costs Vary By Up to 68 Percent

Monthly Costs for 65 Year Old Range From $118 to $444 According to Medicare Supplement Insurance Association's 2016 Price Index

American Association for Medicare Supplement InsuranceApril 4, 2016 10:18 AM

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Medicare Supplement insurance expert, Jesse Slome, head of the American Association for Medicare Supplement …

LOS ANGELES, CA--(Marketwired - April 04, 2016) - A 65-year old male purchasing Medicare Supplement insurance will pay anywhere from a low of $126-per-month to a high of $444-per-month according to the just-published 2016 National Medicare Supplement Price Index.

"Costs for Medicare Supplement insurance, also called Medigap, vary significantly for both men and women," reports Jesse Slome, director of theAmerican Association for Medicare Supplement Insurance (AAMSI), which released the first phase of the study that compares rates for the top-10 metropolitan areas.

According to the Price Index, a 65-year-old woman will pay as little as $118-per-month in San Antonio, TX to as much as $444 monthly if she lives in Manhattan, NY. The Association study examined costs and reported percentage differences between the low and high rates. "For a 65-year old male, the average difference was 39 percent," Slome notes. "For 65-year-old females, the average difference was 34 percent but in some cities the spread between the lowest and highest costs is as much as 48 percent."

Some 12.2 million Americans were protected by Medicare Supplement insurance in 2015 a significant increase compared to 2010 when 9.7 million owned a Medigap policy. "More Americans value the significant benefits and advantages these policies provide," Slome shares. "With 10,000 Americans turning 65 every day, the number of Medigap policyholders will continue to grow."

The Association examined monthly rates for Medicare Supplement Plan F, the most commonly purchased coverage. "Some 66 percent of individuals choose Plan F," Slome shared. Private insurers offer Medigap policies but the government has standardized coverage by assigning a specific letter to make it easier to comparison shop. Three states that had standardized policies before the federal law passed follow different rules.

"Prices vary and no single insurer was consistently the least expensive nor the most expensive," Slome says the study found. "Consumers who want the best coverage for the lowest cost would be well served by working with a knowledgeable Medicare Supplement insurance agent who can educate and help you with the comparison shopping."

Highest Costs in New York City; Lowest Costs In San Antonio, Texas

Among the top-10 U.S. cities, the highest cost for Plan F coverage was $444-per-month for a 65-year-old male living in Manhattan, New York according to the Price Index. The lowest cost was $126-per-month for a male living in San Antonio, Texas. For a 65-year-old female, the highest cost was $444 and the lowest was $118 for the same cities.

Jesse Slome is director of the American Association for Medicare Supplement Insurance, established to provide consumer awareness and education, marketing support and networking opportunities for professionals who market Medigap insurance.

The organization maintains the nation's largest online directory of local independent Medicare Supplement insurance professionals at www.medicaresupp.org or call AAMSI at 818-597-3205 for information.

Slome is a leading national advocate for consumer awareness and financial and insurance product education. He has authored over 25 comprehensive consumer books and guides, and recently established the National Advisory Center for Short Term Care Information. He is the author of the soon-to-be published Essential Guide to Short-Term Care Insurance Protection.

Image Available: http://www.marketwire.com/library/MwGo/2016/4/1/11G091419/Images/Slome-MedSupp-HigherRes-66211bbbebf2a91a90b790a8b673cd45.jpg

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