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Medicare Part A
Medicare Part A pays for inpatient hospital, skilled nursing care and some home health care. Most seniors are automatically enrolled in Medicare Part A when they turn 65. For 2017, the Medicare Part A deductible is $1,316.00 for the first 60 days. Cost share in 2016 for days 61-90 is $329.00 per day (you pay) and $658.00 per day (you pay) for 91 days and beyond. For beneficiaries in skilled nursing facilities, the daily co-insurance for days 21-100 is $164.50 for 2017.
Medicare Part A is free of premium cost for those who have 40 or more quarters of Medicare-covered employment. Seniors with 30-39 quarters may purchase Part A for $227.00 monthly premium. Seniors with less than 30 quarters or who are otherwise not eligible for premium-free Part A would pay a monthly premium of $413.00 for Medicare Part A.
Medicare Part B
Medicare Part B pays for physician services, outpatient hospital services, certain home health services and durable medical equipment. Part B enrollment is not automatic at age 65 and seniors must elect Part B either when they turn 65 or when they lose employer-sponsored health coverage if they work past age 65 (seniors can elect Medicare Part B even if they are covered under an employer-sponsored plan as an employee or they can choose to defer Part B enrollment). Premium for Medicare Part B for 2017 is $134.00 for most seniors (it can be higher depending on income). Generally the monthly Part B premium will be deducted from a senior's Social Security check automatically. The Medicare Part B deductible for 2017 is $183.00.
Medicare Part C
Medicare Part C is the Medicare Advantage program. Medicare Advantage Plans are private health insurance plans approved by Medicare and are used in place of Original Medicare. Part C plan benefits may not cover less than original Medicare, but may cover more. Premiums for Part C Medicare Advantage Plans can range from $0 per month to over $100 per month. Medicare Advantage Plans often include prescription drug coverage (Part D) and these are referred to as MAPD (Medicare Advantage Prescription Drug) Plans. Medicare Advantage Plans are now all HMO plans in California. When a senior enrolls in a Medicare Advantage Plan, the carrier's provider network, formulary drug network and any co-pays, deductible and co-insurance are all determined by the health plan, not by Medicare.
In addition to MAPD, there are MA only plans (Medicare Advantage) which do not include the Part D prescription drug benefit. It is very important to remember that a senior may not enroll in a Medicare Advantage (MA only) plan that is an HMO or PPO plan and purchase a stand-alone Part D drug plan. Only the MA FFS plans are allowed to be combined with a stand-along prescription drug (Part D) plan.
Medicare Part D Medicare Part D is the Medicare Prescription Drug benefit. Part D plans may be purchased as a stand-alone plan to accompany original Medicare, original Medicare plus a Supplement, or an MA FFS plan. Part D plans are available for seniors from a variety of private health insurers as well as the base Part D plan directly from Medicare. Part D drug plans have a deductible, then cost share, then what is referred to a the donut hole (no cost sharing senior pays all) then full coverage. There are many variations between Part D drug plans in terms of how each handles the deductible and cost-sharing. Additionally, some carriers are offering Part D drug plans in conjunction with specific pharmacy providers such as Walgreens, CVS, Rite Aid and Walmart.
I am happy to assist my Medicare Supplement clients with finding Part D drug plans as an added service. I don't sell Part D drug plans on a stand-alone basis.
A Medicare Supplement is a private plan also known as a Medigap plan. Supplements are standardized and identified by letter (A-N). Some Medicare Supplement plans were eliminated as redundant with the Medicare Modernization Act. Each Medicare Supplement plan (by letter) has a different level of gap coverage and the plans are intended to help fill the gaps (costs to seniors) in original Medicare. Because Medicare Supplements are standardized, each Supplement of a certain letter (for example: Plan F) must offer identical gap coverage. Medicare Supplements charge a monthly premium and pay gaps after Medicare pays it's portion of cost for covered services.
California 'Birthday Rule' - California law provides an annual open enrollment for those Medicare beneficiaries who have a Medicare Supplement plan. This is known as the Birthday Rule. The law allows any beneficiary to enroll in any available carrier's "like or lesser" Supplement plan without underwriting on their birthday plus 30 days thereafter in replacement of their current supplement. Like or lesser meaning supplemental benefits equal to (same letter ) or less than the current supplement plan. Plan F members can move to any other supplement as every plan would be considered like or lesser. For more details, contact me.
CA Insurance Code 10192.11 (h) (1) An individual shall be entitled to an annual open enrollment period lasting 30 days or more, commencing with the individual's birthday, during which time that person may purchase any Medicare supplement policy that offers benefits equal to or lesser than those provided by the previous coverage. During this open enrollment period, no issuer that falls under this provision shall deny or condition the issuance or effectiveness of Medicare supplement coverage, nor discriminate in the pricing of coverage, because of health status, claims experience, receipt of health care, or medical condition of the individual if, at the time of the open enrollment period, the individual is covered under another Medicare supplement policy or contract. An issuer shall notify a policyholder of his or her rights under this subdivision at least 30 and no more than 60 days before the beginning of the open enrollment period.
Blue Shield of California has announced an increase the the "New To Medicare" Discount on Medicare Supplement Plans A, C, D , F & G. The discount changes from $15 per month to $25 per month on supplements with 8/1/17 or later effective dates. An additional $3 per month discount is available for using Easy$Pay to pay premiums. All Blue Shield Medicare Supplement Plans include free Silver Sneakers Fitness Program. Blue Shield discount applies during first 12 months so if you enroll any time during your 12 month eligibility period, you get the discount for the remaining months only.
Anthem Blue Cross offers $20 per month Plan F (also applies to Innovative F) Discount for "New To Medicare" beneficiaries. The Anthem discount works a little differently from Blue Shield. With Anthem, you must enroll within the first six months of your initial Part B enrollment. Anthem then allows a full 12 months of discount on Plan F even if you enroll in month six. Anthem also offers $2 per month additional discount if you use autopay. Anthem Supplements now include Silver Sneakers Fitness Program.
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Medicare Supplements (Medigap) for California Seniors 65+