Tom Milonas » Part B

Comparing Medicare Supplement Insurance Plan Coverage

Tom Milonas — Thu, 19 Mar 2009 13:03:37 +0000

For seniors who want supplement insurance, many private insurance companies offer Medicare Advantage plans with low premiums. Eligible seniors include those enrolled in Medicare Part B. Premiums are offered at lower rates because the federal government provides insurance companies subsidies to enroll seniors in the medicare supplement plans.

The Medicare Advantage medical coverage is offered by private insurance companies and is an alternative to Medicare. The following types of Medicare Advantage plans all offer medical and drug coverage together, making it simpler to purchase one policy instead of several separate policies.

1)Medicare health maintenance organizations are less expensive, but there are limitations about going outside of the network of doctors and hospitals for medical treatment.

2)Preferred-provider organizations, have a network of preferred doctors and hospitals within a state. They allow patients to see providers out of the network at increased copayments.

3) Private fee-for-service plans allows the most freedom by letting the patient see any doctor of choice that accepts the health insurance. If you already have a doctor, make sure they participate as a provider before deciding on this type of coverage.

Many Medicare Advantage plans also include vision and dental coverage and have lower copays than Medicare. Although the co-pays for more expensive services such as hospitilization and surgery tend to be higher. If seniors have had hospitalizations in the past, make sure to check out the limitations on hospital coverage with the Medicare Advantage plans.

It is important to understand all the restrictions for Medicare Advantage plans before choosing. Take the time to ask a reputable insurance agent about all the Medicare options available and compare them with other types of supplemental insurance to make an informed decision about your medical coverage.

By Guest Writer: Elliot Bigman

What Does Dual Eligible Mean?

Tom Milonas — Thu, 01 May 2008 17:10:37 +0000

Medicare / Medicaid Dual Eligibles

Dual eligibles are individuals who are entitled to Medicare Part A and/or Part B and are eligible for some form of Medicaid benefit.

Medicare – Medicaid Relationship

The Medicare Program (Title XVIII of the Social Security Act) provides hospital insurance, also known as Part A coverage, and supplementary medical insurance, also known as Part B coverage. Coverage for Part A is automatic for people age 65 or older (and for certain disabled persons) who have insured status under Social Security or Railroad Retirement. Most people don’t pay a monthly premium for Par A. Coverage for Part A may be purchased by individuals who do not have insured status through the payment of monthly Part A premiums. Coverage for Part B also requires payment of monthly premiums.

People with Medicare who have limited income and resources may get help paying for their out-of-pocket medical expenses from their state Medicaid program. There are various benefits available to “dual eligibles” who are entitled to Medicare and are eligible for some type of Medicaid benefit. These benefits are sometimes also called “Medicare Savings Programs” (MSP).

For people who are eligible for full Medicaid coverage, the Medicaid program supplements Medicare coverage by providing services and supplies that are available under their states Medicaid program. Services that are covered by both programs will be paid first by Medicare and the difference by Medicaid, up to the states payment limit. Medicaid also covers additional services (e.g., nursing facility care beyond the 100 day limit covered by Medicare, prescription drugs, eyeglasses, and hearing aids).

Limited Medicaid benefits are also available to pay for out-of-pocket Medicare cost-sharing expenses for certain other Medicare beneficiaries. The Medicaid program will assume their Medicare payment liability if they qualify. Qualified Medicare Beneficiaries (QMBs), with resources at or below twice the standard allowed under the Supplemental Security Income (SSI) program and income at or below 100% of the Federal poverty level (FPL), do not have to pay their monthly Medicare premiums, deductibles, and coinsurance. Specified Low-Income Medicare Beneficiaries (SLMBs), with resources at or below twice the standard allowed under the SSI program and income exceeding the QMB level, but less than 120% of the FPL, do not have to pay the monthly Medicare Part B premiums. Qualifying Individuals (QIs), who are not otherwise eligible for full Medicaid benefits and with resources at or below twice the standard allowed under the SSI program, will get help with their monthly Medicare Part B premiums, if their income exceeds the SLMB level, but is less than 135% of the FPL.

Individuals who were receiving Medicare due to disability, but have lost entitlement to Medicare benefits because they returned to work, may buy Medicare Part A. If the individual has income below 200% of the FPL and resources at or below twice the standard allowed under the SSI program, and they are not otherwise eligible for Medicaid benefits, they may qualify to have Medicaid pay their monthly Medicare Part A premiums as Qualified Disabled and Working Individuals (QDWIs).

To learn more about Medicaid eligibility and/or the Medicare Program, see Related Links Inside CMS at the bottom of the page.

Screening Tools

Screening tools are available to help assess an individual’s eligibility for a variety of governmental programs, including Medicaid and/or Medicare, by accessing the GovBenefits and BenefitsCheckUp websites. (See Related Links Inside CMS and Related Links Outside CMS at the bottom of page.)

Integrated Medicare and Medicaid Models

CMS has created a specific website to provide information about our initiative for Integrated Care programs. This website provides valuable resources regarding integrated Medicare and Medicaid programs for States, health plans, and providers.

Source www.medicare.gov

Medicare / Medicaid Dual Eligibles

Dual eligibles are individuals who are entitled to Medicare Part A and/or Part B and are eligible for some form of Medicaid benefit.

Medicare – Medicaid Relationship

To learn more about Medicaid eligibility and/or the Medicare Program, see Related Links Inside CMS at the bottom of the page.

Screening Tools

Integrated Medicare and Medicaid Models

What are the “Election Periods”?

Tom Milonas — Sat, 05 Jan 2008 15:37:50 +0000

So much attention is focused on the Annual Coordinated Election Period (AEP) for Medicare Advantage (MA) plans and prescription drug plans (PDPs) that beneficiaries and their advocates may be unaware of other Medicare enrollment periods. These enrollment periods and their acronyms are confusing and overlapping. A beneficiary who does not act carefully may lose needed Part B or Part D coverage or may affect the way Medicare services are received. In some situations beneficiaries have only two weeks left, until the end of March, to effectuate a change.

Annual Coordinated Election Period (AEP)

The Annual Coordinated Election Period runs from November 15 through December 31 each year. During this time beneficiaries may change prescription drug plans, change Medicare Advantage plans, return to original Medicare, or enroll in a Medicare Advantage plan for the first time. Enrollment changes take effect on January 1.

General Enrollment Period (GEP)

Medicare beneficiaries who did not enroll in Part B when they first became eligible for Medicare may elect Part B coverage during the General Enrollment Period, which extends from January 1 through March 31 each year. Enrollment becomes effective on July 1 of the same year.

Beneficiaries who delay enrollment in Part B will be assessed a late enrollment penalty on their Part B premium. The penalty is 10% for each full year of delayed enrollment for as long as the beneficiary remains covered under Part B.

Someone who enrolls in Part B during the General Enrollment Period also has a Special Enrollment Period (SEP) for Part D. From April through June of each year a new Part B enrollee may make one election to join a Part D plan. Because beneficiaries who only have Part A and not Part B are not eligible to enroll in a Medicare Advantage plan, the SEP enables beneficiaries who elect Part B during the General Enrollment Period to enroll in a Medicare Advantage plan with drug coverage (MA-PD).

Open Enrollment Period (OEP)

The Open Enrollment Period provides Medicare beneficiaries with one opportunity to enroll in, disenroll from, or change a Medicare Advantage plan. Like the General Enrollment Period, the Open Enrollment Period extends from January 1 through March 31 each year. Unlike enrollment in Part B, the change in Medicare Advantage enrollment or disenrollment becomes effective the month after the change is made.

Only beneficiaries who are eligible to enroll in a Medicare Advantage plan may make a change during the Open Enrollment Period. In other words, a beneficiary who wants to change must have both Medicare Part A and Medicare Part B and must live in the area served by the Medicare Advantage plan.

Beneficiaries may not add or drop Part D drug coverage during the Open Enrollment Period. Those who already have drug coverage can only change to another option with drug coverage. Those who do not have drug coverage may not change to an option that provides drug coverage. Permissible changes during the Open Enrollment Period include:

MA-PD to a different MA-PD
MA-PD to Original Medicare and a PDP
Original Medicare and a PDP to an MA-PD
MA-only plan to a different MA-only plan
MA-only plan to original Medicare
Original Medicare to an MA-only plan

Beneficiaries who want to use the Open Enrollment Period to return to Original Medicare from an MA-PD must do so by enrolling in a PDP. Enrollment in a PDP during either the Annual Coordinated Election Period or the Open Enrollment Period terminates enrollment in a Medicare Advantage plan. Because beneficiaries are generally limited to changing their prescription drug coverage during the Annual Coordinated Election Period, MA-PD enrollees who want to return to Original Medicare during the Open Enrollment Period have a Part D Special Enrollment Period that allows them to make one enrollment into a PDP.

Limited Open Enrollment Period (L-OEP)

Congress created a new enrollment period for 2007 and 2008, the Limited Open Enrollment Period, as part of the Tax Relief and Health Care Act of 2006. The Limited Open Enrollment Period allows someone in Original Medicare to enroll in a Medicare Advantage plan without drug coverage (MA-only plan) at any time of the year. Enrollment becomes effective the month after the choice is made. A beneficiary in an MA-only plan may not use the Limited Open Enrollment Period to return to Original Medicare.

The Centers for Medicare & Medicaid Services (CMS) has indicated that beneficiaries who use the Limited Open Enrollment Period to join a private fee-for-service plan without drug coverage will be able to keep their PDP. However, those who use the limited open enrollment period to enroll in an HMO, local PPO, or regional PPO that does not offer drug coverage will lose their prescription drug coverage.

Beneficiaries who lose drug coverage as a result of a choice made during the Limited Open Enrollment Period will be assessed a late enrollment penalty on their Part D premiums for any month in which they did not have drug coverage.

CMS has stated that MA-only plans will be required to contact potential enrollees to make sure they understand that they will lose their prescription drug coverage and to confirm that they still want to join the plan before enrollment is effectuated. In response to a letter from beneficiary advocates raising concerns about CMS’s interpretation of the new law, CMS has indicated that it will establish a Special Enrollment Period on a case-by-case basis to allow beneficiaries to disenroll from the MA-only plan and to return to their PDP if they were unaware that they would lose their drug coverage.

Special Enrollment Period (SEP)

Special Enrollment Periods allow beneficiaries to make an enrollment change outside of the GEP, the AEP, the OEP and the L-OEP.

Beneficiaries who delay enrolling in Part B because they are covered by employer-sponsored health insurance as an active worker or as a dependent of an active worker are not limited to enrolling in Part B during the GEP. They have an SEP that runs for eight months from the time they (or their spouse) retire or they lose their health insurance. Part B coverage starts the month after the election is made, and no late premium penalty is assessed.

A number of SEPs exist for Medicare Advantage and PDP enrollment and disenrollment. For example, someone who moves out of a Medicare Advantage Plan or PDP service area has an SEP to enroll in a plan that serves their new home. Beneficiaries who move into, reside in, or move out of a nursing home may also have an SEP. Individuals who are eligible for Medicare and Medicaid have an SEP that allows them to change Part D drug plans at any time. CMS has the authority to create SEPs for exceptional circumstances.

For more details about Part D SEPs see the PDP Eligibility, Enrollment and Disenrollment Guidance, http://www.cms.hhs.gov/PrescriptionDrugCovContra/Downloads/CurrentPDPEnrollmentGuidance.pdf.

The Medicare Advantage SEPS are described in the Medicare Managed Care Manual, Chapter 2, Medicare Advantage Enrollment and Disenrollment, http://www.cms.hhs.gov/HealthPlansGenInfo/Downloads/mc86c02.pdf.