Medicare Plans

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You can choose different ways to get the services covered by Medicare. In most cases, when you first get Medicare, you are in Original Medicare. You may want to consider a Medicare Prescription Drug Plan (Part D) to add drug coverage. Or, you may want to consider a Medicare Advantage Plan (like an HMO or PPO) that provides all your Part A, Part B, and often Part D coverage. You make a choice when you are first eligible for Medicare. Each year you can review your health and prescription needs and switch to a different plan in the fall.

Original Medicare

This fee-for-service plan covers many health care services. You can go to any doctor or supplier that is enrolled and accepts Medicare and is accepting new Medicare patients, or to any hospital or other facility.

Medicare Part A (Hospital Insurance)

Part A helps pay for care in hospitals as an inpatient, critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas), skilled nursing facilities (not custodial or long-term care), hospice care, and some home health care.

Cost:

• Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.

• The Part A premium is $254.00 per month for people having 30-39 quarters of Medicare-covered employment.

• The Part A premium is $461.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.

If you don’t automatically get premium-free Part A, you may be able to buy it if

• You (or your spouse) aren’t entitled to Social Security because you didn’t work or didn’t pay enough Medicare taxes while you worked and you are age 65 or older, or

• You are disabled but no longer get premium-free Part A because you returned to work.

Deductible and Coinsurance Amounts for 2010:

For each benefit period you pay:

• A total of $1,100 for a hospital stay of 1-60 days.

• $275 per day for days 61-90 of a hospital stay.

• $550 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).

• All costs for each day beyond 150 days

Skilled Nursing Facility Coinsurance

• $137.50 per day for days 21 through 100 each benefit period.

Part B (Medical Insurance)

Part B helps pay for doctors' services, outpatient hospital care, and some other medical services that Part A doesn't cover, such as the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

Cost:

• Most Medicare beneficiaries will continue to pay the same $96.40 Part B premium amount in 2010. Beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium and have incomes of $85,000 or less (or $170,000 or less for joint filers) will not have an increase in their Part B premium for 2010.

• For all others, the standard Medicare Part B monthly premium will be $110.50 in 2010, which is a 15% increase over the 2009 premium. The Medicare Part B premium is increasing in 2010 due to possible increases in Part B costs. If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $110.50 per month.

Deductible and Coinsurance Amounts for 2010:

• $155.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $155.00 deductible.)

Medicare Part C - (Advantage Plans)

Advantage Plans are NOT supplemental insurance plans. They must cover all the same services Original Medicare covers, except for hospice services. You are still in the Medicare program. Hospice services are paid by Original Medicare when you enroll in a Medicare approved hospice program, not your Medicare Advantage Plan.

• This coverage is provided by private insurance companies approved by Medicare..

• You will use a card from this plan to get your Medicare-covered services. Do not throw away your red, white, and blue Medicare card. Keep it in a safe place for future use if you leave your plan.

• Once you join a plan, it is responsible for your health care needs as well as all of your claims and/or bills. In other words, the Medicare Advantage Plan will process all of your claims for consideration, not Original Medicare (unless you have a Cost Plan).

• You may have to pay an extra monthly premium in addition to your monthly Part B premium. It is very important to note you will still be responsible for your Part B premium.

• If you join a Medicare Advantage Plan, you will not need, and cannot buy, a Medigap policy. If you already have a Medigap policy, you can keep it, but Medigap will not pay for any plan costs, such as copayments.

Medicare Health Plans (like HMOs and PPOs)

These plans are approved by Medicare and run by private companies. When you join one of these plans, you are still in Medicare. Some of these plans require referrals to see specialists. They provide all of your Part A (hospital) and Part B (medical) coverage. They generally offer extra benefits, and many include prescription drug coverage. These plans often have networks, which means you may have to see doctors who belong to the plan or go to certain hospitals to get covered services. In many cases, your costs for services can be lower than in Original Medicare, but it is important to check with the plan because the costs for services will vary.

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Medicare Part D

Medicare Part D is prescription drug coverage for everyone with Medicare.This coverage may help you lower your prescription drug costs and help youprotect against higher costs in the future. It can give you greater access to drugsthat you can use to prevent complications of diseases and stay well. To get Medicare drug coverage, you must join a plan run by an insurance company orother private company approved by Medicare.

Cost:

• Each plan can vary in cost and drugs covered. If you join a Medicare drugplan, you usually pay a monthly premium.
• If you decide not to join a Medicaredrug plan when you are first eligible, you may pay a penalty if you choose to join later.

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Medigap (Medicare Supplement Insurance)

These policies help pay some of the health care costs that Original Medicare doesn’t cover. If you are in Original Medicare, you could get a Medigap policy to help cover the extra health care costs.

Click here for a chart that gives you a quick look at the standardized Medigap Plans A through L and their benefits.

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