ypes of Medicare Advantage Plans
PPO, HMO, MSA, Cost Plan, PFFS
Medicare-Medicaid plans
Serve both Medicare and Medicaid individuals. Include Part D coverage. Individuals sometimes referred to as dual eligibles
...
ypes of Medicare Advantage Plans
PPO, HMO, MSA, Cost Plan, PFFS
Medicare-Medicaid plans
Serve both Medicare and Medicaid individuals. Include Part D coverage. Individuals sometimes referred to as dual eligibles
Medicare Cost Plan
Type of Medicare health plan. Have Part B to enroll. Can join anytime plan is accepting new members. A non network provider will can charge higher coinsurances and deuctibles. Different enrollment/disenrollment periods apply. Can get Part D Rx coverage if available, or apply for a separate PDP.
Medicare Entitlement/Enrollment - Part A & Part B
Individuals with ESRD may sign up at anytime. Date on which coverage begins is the fourth month after dialysis begins.
Medicare Enrollment Period
Individuals who do not enroll in Part B when first eligible can enroll during a General Enrollment Period, Jan 1st to Mar 31st each year. Coverage begins July 1st of that year.
Medicare Enrollment Period - Group Health Coverage
Individuals who have group health coveage through employer may enroll in Part A and/or Part B anytime while on group coverage during a Special Enrollment Period. Occurs during the 8 month period following last month of group coverage.
Medicare Part A Premium
Free if worked 40 quarters of your life and paid Medicare taxes. Premium is $240.00 for individuals or spouses who paid Medicare taxes for 30 - 39 quarters. Premium is $437.00 for less than 30 quarters.
Medicare Part A Penalty
Don't enroll in Part A when fist eligible, will pay a late penalty of up to 10% unless enroll during a Special Enrollment Period.
Medicare Part B Premium
In 2019, the standard monthly premium is $135.50 or higher depending on income. Deducted from S.S. check or Railroad Retirement check. Do not enroll when first eligible, premium is increased 10% for each 12 month period not enrolled. Deductible for 2019 is $185.00
Part C Medicare Advantage plans
Entiled to benefits under Part A AND enrolled in Part B.
Part D Prescription Drug benefits
Entitled to benefits under Part A but not enrolled in Part B. Must be entitled to Part A AND/OR enrolled in Part B.
Part D Low Income Subsidy
Do not qualify for Part D Low Income Subsidy, but are of limited means, may qualify for help in Part D costs through State Pharmaceutical Assistance Program.
Part A Benefits
$1364.00 deductible for each benefit period. Days 1 - 60: $0 coinsurance. Days 61 - 90: $341.00 coinsurance per day. days 91 and beyond: $682.00 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over a beneficiarys lifetime. Beyond lifetime reserve days, all costs.
Part A Benefits
Blood, hospice, home health care, skilled nursing and rehabilitative care only after a 3 day hospital stay up to 100 days in a benefit period. In 2019, will pay $170.50 coinsurance for days 21 - 100 each benefit period. In patient psychiatric care is 190 lifetime days. Does not cover custodial or long term care.
Part D Prescription Drug Coverage
Late enrollment penalty of 1% of national standard premium for every month that beneficiary could have had Part D but didn't enroll. No penalty for beneficiaries with low income assistance or who join a Part D within 63 days of losing creditable coverage.
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