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.

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.

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Conservative lawmakers, Aetna CEO 

suggest Advantage plans could help save 

Medicare

By Shannon Muchmore and Bob Herman  | March 16, 2016

(Story was updated at 4:27 p.m. ET) 

Lawmakers, health policy experts and the chief executive of one of the nation's largest insurers believe Medicare Advantage could help keep the Medicare program solvent.

On Wednesday, the House Ways and Means Committee's Health Subcommittee held a hearing on Medicare's future. The Medicare board of trustees said in its most recent annual report that Medicare will be able to cover its costs until 2030, but suggested congressional action to strengthen the program's future.

Robert Moffit, a senior fellow at the right-leaning Heritage Foundation, suggested increasing the age of eligibility for Medicare, implementing means testing, expanding direct contribution abilities and combining Medicare Parts A and B.

Health Subcommittee Chairman Rep. Pat Tiberi (R-Ohio) said he agreed with many of those proposals and that changes had to be made to account for the increasing elderly population.

“Despite major improvements and innovations in the healthcare sector that have transformed how care is delivered, traditional Medicare has barreled through the last 50 years on the same trajectory of increased costs and little innovation,” he said.

Medicare reforms pop up every year in Congress during budget battles, butlittle is actually done. Conservatives traditionally have supported a premium-support model for Medicare, while liberals have championed a morestreamlined approach. Single-payer, or Medicare-for-all, also has wide support from many left-leaning economists and supporters, although the industry has opposed that model.

Aetna CEO Mark Bertolini said Wednesday he has another idea.

Medicare Advantage, the private managed-care version of traditional Medicare, will be “the solution to entitlement reform around health benefits,” he said at the annual Barclays Global Healthcare Conference.

Aetna has more than 1.36 million Advantage members, according to March figures from the CMS, and it stands to become the largest Medicare insurer in the country through its $37 billion buyout of Humana.

Bertolini's comments came after he was asked his thoughts about last summer's speed-dating among health insurers. If federal and state regulators approve Aetna's acquisition of Medicare powerhouse Humana, which remains a big “if,” the combined company would have a presence in markets that make up more than 90% of the eligible Medicare population. It would allow Aetna to offer a “nationally portable” Medicare Advantage product that the government believes can help slow down the growth of Medicare's costs, he said.

“I think Medicare fee-for-service is a moving target,” Bertolini said, adding that Medicare Advantage would then become “more of a default program.”

Medicare Advantage already enrolls more than 18 million people and has garnered support from Democrats and Republicans alike, although serious issues have been raised about the program.

For instance, some observers have said Advantage plans are acting “unethically” by inflating patient risk scores conducted during home visits to gain higher payments, but then aren't pursuing follow-up care. Federal policy moves to save Medicare revenue at large players also have caused consternation.

At Wednesday's House committee hearing, Katherine Baicker, a health economics professor at the Harvard Chan School of Public Health, said Medicare Advantage plans should be key to keeping Medicare available for future generations.

A "one size fits all" Medicare program will be increasingly difficult to maintain, she said. “A thriving and competitive Medicare Advantage program can be a vital contributor to high quality beneficiary care in a sustainable healthcare system.”

Rep. Jim McDermott (D-Wash.), the ranking member of the subcommittee, pushed back on the ideas brought forth by his Republican counterparts, saying those plans could “have devastating effects.” He also said Medicare Advantage plans are being overpaid and allowed to cherry-pick healthier beneficiaries.

Stuart Guterman, a senior scholar in residence at AcademyHealth, agreed and said the elderly and disabled are the “least prepared to bear that additional burden.”

“Policymakers are confronted, therefore, with the question of how to continue to slow the growth of total Medicare spending when the spending per beneficiary already is increasing so slowly,” he said.

Harvard's Baicker said more radical changes are needed because the system is out of balance.

“I think something fundamental about the system has to change to preserve the viability of the program,” she said.

Want to see more? Visit this link from modern healthcare: http://www.modernhealthcare.com/article/20160316/NEWS/160319921/conservative-lawmakers-aetna-ceo-suggest-advantage-plans-could-help

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.

Medicare 101: What is Medicare Part A?

Medicare 101: What is Medicare Part A?

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

Medicare can be confusing, but don’t worry. You aren’t the only one feeling that way. Although there are many benefits to Medicare, with its different components and enrollment periods, it can get a little confusing. In this three-part series, we’ll break down Parts A, B, C and D of Medicare down to their essentials. Here are simple answers to the most-asked questions about Part A:

What does Medicare Part A cover?

Medicare Part A combined with Part B, make up what is known as Original Medicare. Part A covers emergency care, hospital stays, some nursing home care, and other long-term visits such as home health services and hospice care.

Who qualifies?

• Seniors (age 65 and above) who are U.S. citizens and permanent residents.
• Individuals with qualified disabilities (age 64 and below).

When should I enroll?

You can enroll during your Initial Enrollment Period (IEP), which usually lasts 7 months:

• Three months before your 65th birthday or 25th disability check.
• Month of your 65th birthday or 25th disability check.
• Three months after your 65th birthday or 25th disability check.

If you miss your Initial Enrollment Period, you can sign up during the General Enrollment Period, which is from January 1 to March 31. If you sign up during this time, your coverage will start July 1. Please note that if you enroll during the General Enrollment Period you may have to pay a higher premium for late enrollment.

Fall Open Enrollment occurs every year between October 15th and December 7th and allows those who already have Medicare to change their coverage. We recommend you review your coverage every year, as this is the one time when all people with Medicare can make changes to their plans for the next year.

How much does it cost?

Part A plans are provided to you at no cost if you or your spouse have worked and paid taxes for at least 40 quarters (or 10 years).

If this isn’t the case, you will pay a monthly premium of up to $407. The exact amount you’ll pay is determined by different factors such as your income and assets.

If you’re concerned about the costs involved that aren’t covered by Medicare, Medicare Supplement Insurance can help cover expenses that you’ll have to pay out of pocket.

For more info, check out Medicare.gov and this chart published by the 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.

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