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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Need Medical Equipment? See what Medicare Covers....

*Repost* https://www.medicare.gov/coverage/durable-medical-equipment-coverage.html?linkId=24566463&utm_source=facebook&utm_medium=social&utm_campaign=medicare&utm_content=071717_DME&linkId=39844787

Durable medical equipment (DME) coverage

How often is it covered?

Medicare Part B (Medical Insurance) covers medically necessary durable medical equipment (DME) that your doctor prescribes for use in your home. Only your doctor can prescribe medical equipment for you. DME meets these criteria:

• Durable (can withstand repeated use)
• Used for a medical reason
• Not usually useful to someone who isn't sick or injured
• Used in your home
• Has an expected lifetime of at least 3 years

DME that Medicare covers includes, but isn't limited to:

• Air-fluidized beds and other support surfaces (these supplies are only rented)
• Blood sugar monitors
• Blood sugar (glucose) test strips
• Canes (however, white canes for the blind aren't covered)
• Commode chairs
• Continuous passive motion (CPM) machine
• Crutches
• Hospital beds
• Infusion pumps and supplies (when necessary to administer certain drugs)
• Manual wheelchairs and power mobility devices
• Nebulizers and nebulizer medications
• Oxygen equipment and accessories
• Patient lifts 
• Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
• Suction pumps
• Traction equipment
• Walkers

Who's eligible?

All people with Part B are covered.

Your costs in Original Medicare

If your supplier accepts assignment, you pay 20% of the Medicare-approved amount, and the Part B deductibleapplies. Medicare pays for different kinds of DME in different ways. Depending on the type of equipment:

• You may need to rent the equipment.
• You may need to buy the equipment.
• You may be able to choose whether to rent or buy the equipment.

Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them. 

It’s also important to ask your suppliers if they participate in Medicare before you get DME. If suppliers are participating suppliers, they must accept assignment. If suppliers are enrolled in Medicare but aren’t “participating,” they may choose not to accept assignment. If suppliers don't accept assignment, there’s no limit on the amount they can charge you.

Competitive Bidding Program

If you live in or visit certain areas, you may be affected by Medicare's Competitive Bidding Program. In most cases, Medicare will only help pay for these equipment and supplies if they're provided by contract suppliers when both of these apply:

• You have Original Medicare.
• You get competitively bid equipment and supplies in competitive bidding areas.

Contract suppliers can't charge you more than the 20% coinsurance and any unmet yearly deductible for any equipment or supplies included in the Competitive Bidding Program.

Note

To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like:

• Other insurance you may have
• How much your doctor charges
• Whether your doctor accepts assignment
• The type of facility
• The location where you get your test, item, or service

Note

If you live in an area that's been declared a disaster or emergency, the usual rules for your medical care may change for a short time. Learn more about how to replace lost or damaged equipment in a disaster or emergency.

Related Resources

• Where to get covered DME items  
• More information about DME
• Competitive Bidding Program

Medicare 2017

Medicare 2017 costs at a glance

Repost by: 

Listed below are basic costs for people with Medicare. If you want to see and compare costs for specific health care plans, visit the Medicare Plan Finder.

For specific cost information (like whether you've met your deductible, how much you'll pay for an item or service you got, or the status of a claim), visit MyMedicare.gov. 

Find out if Medicare covers a specific test, item or service that's not listed under the detailed Medicare cost information section of this page.

2017 costs at a glance
Part A premium	Most people don't pay a monthly premium for Part A (sometimes called "premium-free Part A"). If you buy Part A, you'll pay up to $413 each month. Calculate my premium.
Part A hospital inpatient deductible and coinsurance	You pay:  $1,316 deductible for each benefit period Days 1-60: $0 coinsurance for each benefit period Days 61-90: $329 coinsurance per day of each benefit period Days 91 and beyond: $658 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime) Beyond lifetime reserve days: all costs
Part B premium	The standard Part B premium amount is $134 (or higher depending on your income). However, most people who get Social Security benefits will pay less than this amount ($109 on average).
Part B deductible and coinsurance	$183 per year. After your deductible is met, you typically pay 20% of the Medicare-approved amountfor most doctor services (including most doctor services while you're a hospital inpatient), outpatient therapy, and durable medical equipment.
Part C premium	The Part C monthly premium varies by plan. Compare costs for specific Part C plans.
Part D premium	The Part D monthly premium varies by plan (higher-income consumers may pay more). Compare costs for specific Part D plans.

Detailed Medicare cost information for 2017

expand iconMedicare Part A (Hospital Insurance)

expand iconMedicare Part B (Medical Insurance)

expand iconMedicare Part C (Medicare Advantage)

expand iconMedicare Part D (Medicare prescription drug coverage)

Read More @: https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html

You’re 65 and Working: What about Medicare?

Repost: 
Medicare Tips & Resources | Tue, Jun 14, 2016 @ 09:00 AM

You’re 65 and Working: What about Medicare?

Posted by Medicare Made Clear: Retirement used to be closely linked to turning 65. No more. The full retirement age — when you can receive 100% of your social security retirement benefit — is 66 for anyone born in 1943. And, it’s 67 if you were born in 1960 or later.

However, Medicare eligibility still begins at age 65, even if retirement does not. People on disability could be eligible for Medicare before they turn 65.The question is: What do employed 65-year-olds do about Medicare

Medicare Before You Retire? Maybe

If you or your spouse is working, then you may have health insurance through an employer. It’s important to understand how Medicare may work with your existing insurance.

Before you do anything about Medicare, you need to talk with your employer health plan administrator. Questions you may want to ask include:

• What kind of health plan do I have? For example, many employer plans are HMOs (health maintenance organizations).
• Does my employer require that I enroll in Medicare?
• How would my health insurance change if I enrolled in Medicare?
• How much is deducted from each paycheck for health insurance? (Remember that you do not pay taxes on payroll deductions for health insurance. You need to consider the tax savings to determine the total value.)

This information may help you evaluate your Medicare choices and decide what’s best for you.

Enroll in Medicare Part A? Probably

Most people enroll in Medicare Part A (hospital coverage) when they turn 65, whether they are working or not. This is because Part A is premium-free for most people. You earn this benefit by paying into the Medicare program while you’re working. You qualify for premium-free Part A if you or your spouse contributed to Medicare for at least 10 years.

In general, hospital expenses are covered first by your employer health plan. Medicare Part A is the secondary payer. It’s a good idea to enroll in Part A as soon as you’re eligible, so you don’t have to worry about signing up later.

There may be reasons to delay Part A, such as if your employer health plan is a Health Savings Account (HSA)—employer contributions could stop if you have Medicare. It’s very important for you to learn how Medicare may change your employer health benefits.

Enroll in Medicare Part B? Depends

Medicare Part B (doctor and outpatient coverage) charges a premium. In 2016, the monthly premium starts at $121.80 per month for new enrollees. It may be more for people with higher incomes.

Many people who have employer coverage delay enrolling in Part B to postpone paying the premium. You can sign up later during a Special Enrollment Period without penalty.

Part B may be of limited value when you have other health insurance. Exceptions may be people who are self-employed or who work for an employer with less than 20 full-time employees, since Medicare would become the primary payer in these situations.

It’s very important to find out how Part B would work with your employer plan before making your decision.

Conclusion

You have a number of Medicare decisions to make when you become eligible for Medicare. This is especially true when you have other health insurance. You may want to start learning about your choices ahead of time. Preparation may help you avoid unnecessary costs.

Brought to you by UHC - Medicare Made Clear 

https://blog.medicaremadeclear.com/Youre-65-Working-What-Medicare/?utm_source=facebook&utm_medium=social&utm_campaign=post&utm_content=blog2016_kcR&WT.mc_id=880576

Medicare 101: What is Medicare Part B?

TransAmerica Page: Medicare 101: What is Medicare Part B?

Now that you’ve learned about Medicare Part A, you may also be wondering what Part B can do for you. While Part A will help you with things like hospital stays and skilled nursing facility care, Medicare Part B helps with other areas in which you may need coverage. Find out what Medicare Part B covers and if it’s for you.

What does Medicare Part B cover?

You may remember that in Part A, we explained Original Medicare is the term used when a plan combines Part A with Part B. That’s because in addition to the benefits Part A will give you, Part Bcovers clinical research, ambulance services, durable medical equipment, mental health (inpatient, outpatient, and partial hospitalization), the ability to get a pre-surgery second opinion, and limited outpatient prescription drugs.

Who qualifies?

If you aren’t eligible for premium-free Medicare Part A, not to worry; you can buy Part B without having to buy Part A. Here are the qualifications you need to meet:
• 65 years or over
• A U.S. Citizen or permanent resident who has legally been in the country for five consecutive years

When should I enroll?

Much like with Medicare Part A, Part B’s has a seven-month Initial Enrollment Period. This means anywhere between the three months prior to month you turn 65, and the three months after that. For example, if your birthday is in April, you are eligible from January through July.

However, if you don’t sign up within that time, you may have to pay a late enrollment penalty for the entire time you have Part B. According to Medicare.gov, “Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B, and coverage will start July 1 of that year.”

How much does it cost?

If you signed up for Part B when you became eligible, then you’ll likely pay a $104.90 premium each month, according to Medicare.gov. Though, this premium can change based on your income, and recent reports indicate it will cost more for a few select groups in the future.

There are some people who automatically get Part B. If you receive Social Security benefits, Railroad Retirement Board (RBB) benefits, are under 65 years old with a disability, have ALS, or live in Puerto Rico and receive Social Security or RBB benefits, then you are eligible for automatic enrollment.

With these benefits, it’s possible that you still don’t feel like you’re getting the coverage that you need. In that case, you can get supplemental Medicare insurance plans.

For more information on Medicare, check out Transamerica Center for Health Studies^®‘s handy guide.

About Transamerica Center for Health Studies^®.
The Transamerica Center for Health Studies^® (TCHS) is a division of the Transamerica Institute^®, a nonprofit, private foundation. TI is funded by contributions from Transamerica Life Insurance Company and its affiliates and may receive funds from unaffiliated third parties. TCHS is dedicated to identifying, researching and analyzing the most relevant health care issues facing consumers and employers nationwide. For more information about TCHS, please visit www.TransamericaCenterforHealthStudies.org.