Medicare advantage plans cover the Medicare holes so that you do not bear the cost which original Medicare will leave you with. Let’s talk about some of the common terms you need to keep in mind with Medicare and a Medicare Advantage Plan:
California Open Enrollment – (Applied in California) the ability of a Medicare advantage member to change to another company each year in the month of their birthday. This is a guaranteed option. You will not be refused the transfer because of your health status.
Original Medicare – Operated by the Federal Government and covers both Part A and Part B.
Medicare Part A – is the hospital coverage Medicare will cover. You are responsible for the deductible of $ 1,100 each 60 day period that you visit a hospital.
Medicare Part B – Outpatient Medicare coverage for physician, specialist and surgical services. There is a Part B annual deductible of $ 155 , which you must pay at the beginning of each calendar year when you see a doctor.
Part B Cost – All Medicare beneficiaries must pay their Part B premium. In 2010, the monthly premium was $ 96.40. If your annual income is higher than $ 85,000, your premium will increase to $ 110.50. (Other rules apply).
Assignment – an agreement by which a doctor or hospital accepts Medicare-approved amount as full compensation for the services and supplies covered by Part B. Medicare will normally pay 80% of the approved amount directly to the doctor after the beneficiary has met the deductible of Part B i.e. $ 155.00. The Medicare Advantage member pays the other 20%.
Nursing Facility – (Medicare Part A) A medical facility primarily used for rehabilitation. Patients are typically in a care facility when recovering from an accident, illness or surgery. Medicare usually pays all costs except $ 137.50 per day. Medicare will not continue to pay for this service if the person has a degenerative disease. In other words, the condition of the patient should improve, if not, the care will cease and long-term care insurance policy or Medicaid will be required to continue to pay these benefits.
Medicare Part D – Medicare Prescription Drug Coverage. Helps to cover the cost of prescription drugs. Must be purchased from a private insurance company.
Part B Co-insurance – After deducting Part B, Medicare requires you to pay 20% of all eligible Medicare costs for doctor, specialist, ambulance and hospital outpatient services and material.
Excess Costs – If your medical bill for Part B benefits exceeds Medicare costs. For example; If the Medicare fee for a particular visit or procedure is $ 150, Medicare Part B will pay $ 120 and the Medicare Advantage pays the balance of $ 30 left if the Medicare Advantage pays for surpluses. Some plans do not cover this surcharge.
Initial Enrollment Period – (IEP) Your enrollment is guaranteed if you apply for insurance cover before or within six months of signing up for Medicare Part B.
The above terms are some of the most common terms regarding a Medicare Advantage plan and you should familiarize yourself with these terms and conditions when purchasing a plan. Please contact a Medicare specialist for more information.