Don Osborn
MTN Health Insurance, LLC

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Medicare Advantage

Medicare

Medicare Part A is automatic, usually has no premiums, and covers:

• Hospital inpatient care:
  You pay a deductible of $1,024 for the first 60 days,
  $256 per day for days 61-90 ($7,424), and
  $512 per day for days 91-150 ($30,208),
  and all costs for each day beyond 150 days.
• Skilled nursing facilities (not long term care):
  You pay $128 per day for days 21-100 ($10,112)
• Home health care services
• Hospice care
• Durable medical equipment
• Transfusion

Medicare Part B is optional, costs $96.40 per month (in 2008) for most policy holders, has an annual deductible of $135, and covers 80% of the Medicare approved amount for:

• Outpatient services
• Physician services
• Diagnostic services
• Ambulance rides
• Other Durable Medical Equipment

If you don’t enroll in Medicare Part B when you are first eligible, the cost of Medicare Part B will go up 10% for each full 12-month period that you could have had Medicare Part B, but didn’t sign up for it (except in special cases). You may have to pay this penalty as long as you have Part Medicare Part B.

Medicare Part B does not, with lots of exceptions, cover:

• The annual deductible of $135
• 20% of what is covered
• Acupuncture
• Chiropractic services
• Cosmetic surgery
• Custodial care
• Diabetic supplies
• Eye care
• Foot care
• Hearing aids
• Laboratory tests (screening)
• Long-term care (nursing homes)
• Orthopedic shoes
• Physical exams (routine)
• Services while traveling outside of the U.S.
• Prescription drugs (see Medicare Part D)

Medigap is the first of three Medicare Insurance options.

Medigap supplemental insurance policies are sold by private insurance companies to Medicare beneficiaries to fill the "gaps" in the original Medicare Plan coverage. There are standardized Medigap policies, labeled Plan A through Plan L. Not all Medicare supplemental insurance carriers offer all plans in all counties. If you want to know which Medicare supplemental insurance plans are available in your county, request a plan summary and quote. For a more detailed description of Medigap plans go to Medigap descriptions. Remember, not all Medicare supplemental insurance plans may be offered in your county.

Medicare part C
Medicare Advantage is the second of three Medicare insurance options. If you have one of these plans, you don’t need a Medigap policy. Medicare “Part C”, also called “Medicare Advantage” is optional. The four basic options in Medicare Advantage are: PPO's, HMO's PFFS's and MSA's. These optional policies allow private carriers to combine Medicare Part A (Hospital), and Medicare Part B (doctors). If you enroll in a Medicare Advantage plan you usually get additional benefits. Note: You must continue to pay your Medicare Part B premiums, in addition to any optional Medicare Part C premiums.

Medicare Part D
Medicare Part D Plans, also called “Medicare Prescription Drug Plans” (PDP) cover medically necessary drugs, that are not covered by Medicare Part A or B. Medicare Part D plans may be purchased as stand alone policies, or are included in many of the Medicare Part C policies.

Note: You must continue to pay your Medicare Part B premiums, in addition to any optional Medicare Part D policy you decide to purchase.
If you don’t join a Medicare drug plan when you are first eligible, you may have to pay a late enrollment penalty when you do join.

To estimate your penalty, take 1% of the national average premium ($27.93 for 2008). Multiply it by the number of full months you were eligible to join a Medicare drug plan but didn’t. This is your estimated penalty amount.

Example, If you waited one year to join: 12months*$27.93*1%=$3.35 penalty to add to your monthly premium.