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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Medicare 2017

Medicare 2017 costs at a glance

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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

Medicare 101: What is Part D?

What Is Medicare Part D and Who Qualifies?

*Repost* Brought to you by: TransAmerica: http://blog.transamerica.com/what-is-medicare-part-d#.V_QNDOUrJhE

Medicare Part A and B together make up what is known as Original Medicare and provide coverage for many things that are typically categorized as hospital insurance and medical insurance, including emergency care. But often, taking care of your daily health comes with medicines prescribed by your doctor. This is where Medicare Part D enters your healthcare picture.

What does Medicare Part D cover?

Simply put, Medicare Part D covers a patient’s prescription drugs. In the Medicare system, drugs are put intotiers based on formularies, which results in different price levels. Medicare Part D plans are generally set up to provide coverage at levels that correspond to the prescription drug tiers. In this guide, you can find a description of some common situations people face, as well as things to consider in each scenario regarding coverage options.

Who qualifies?

Medicare Part D is voluntary for everyone except those enrolled in Medicaid, or Medi-Cal for those in California. Because of that, anyone who is eligible for Medicare can sign up for a Part D coverage during the annual open enrollment period.

When should I enroll?

Enrollment follows the same initial rules as Plans A and B. You can apply three months before the month of your 65th birthday, within your 65th birthday month, and the three months following. Likewise, if you don’t select drug coverage when you first become eligible, and don’t qualify for an exception, you may encounter a late enrollment penalty that stays with you as long as you have Medicare drug coverage.

You don’t have to re-enroll each year, but you will have a chance to review your coverage and change plans if needed. In addition, certain changes in your circumstances throughout the year may prompt the need for aSpecial Enrollment Period (SEP). Rules for what you can change and when you can change it are different for each SEP.

How much does it cost?

The cost for prescription drug coverage isn’t as clear cut as with Parts A and B, since your cost will largely depend on which prescription drugs you take. Other variables include the plan you choose, if you use a pharmacy in your plan’s network, and if your prescriptions are part of the formulary of your chosen plan.

Since coverage for Part D is distributed through independent companies, you have a lot of options to choose from. We can assist you in getting started.

What about Part C?

Original Medicare is enough coverage for some people, but if you feel like you need extra benefits, that’s where Part C comes in. Part C plans are sometimes called Medicare Advantage plans. Medicare Advantage Plans are administered by private insurance providers, but are regulated by the government. They include most Part A and B benefits as well as prescription drug coverage, vision, hearing and dental services. Opting into a Part C plan means that you’ll receive benefits from Medicare Advantage instead of Original Medicare. Costs vary by plan.

For more information on Medicare, Transamerica Center for Health Studies^® has a guide that can help you compare the features of the different parts.

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.

Medicare 101: What is Part C?

Medicare 101: What is Medicare Part C?

*Repost* Brought to you by: TransAmerica: http://blog.transamerica.com/medicare-101-part-c#.V_QMAuUrJhE

If you’re choosing your Medicare insurance plan, or helping your parents choose theirs, the details can get a little confusing. We already helped lay out Part A and Part B for you, so now it’s time to explain Part C.

Medicare has four parts: A,B,C, and D. Each has a different benefit to offer you, but Part C is a little different than the others. Parts A and B together provide what’s called Original Medicare under the public healthcare system. Part C is different in that it is offered through private companies approved by Medicare.

What does Medicare Part C cover?

Medicare Part C, also called Medicare Advantage plans, are private plans, like Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS), and others. These plans must offer the same benefits as Original Medicare. However, the costs associated with your healthcare services will vary depending which plan you choose.

Some people choose these plans over Original Medicare because they can offer additional benefits and cover more services, though that isn’t guaranteed for every plan.

Who qualifies?

Qualifying for Medicare Part C is fairly simple. People who qualify for Medicare Part C are already enrolled in both Medicare Part A and B. A person must also choose a Medicare Advantage plan that’s in the service area he or she lives in.

When should I enroll?

Like with Medicare Parts A and B, you’ll need to enroll when you first become eligible, and can change plans during the Open Enrollment Period (October 15-December 7). To unenroll, you’ll need to do so between January 1-February 14.

Your Initial Enrollment Period is seven months long, and starts three months before your 65th birthday, includes you birthday month, and the following three months after that. After this time, you’ll have to wait for Open Enrollment to sign up.

How much does it cost?

The cost will vary according to which plan you choose for yourself, but since Part C is still a part of Medicare, you’ll have to keep paying your Part B premium. The out-of-pocket costs will also differ, according to your chosen plan.

If you’re looking to add coverage to what Original Medicare offers you, then Part C may be a good option. However, if you still have some questions, you can find the answers on Medicare.gov.

You can also get more information about Medicare from Transamerica Center for Health Studies^®’ helpfulguide.

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.