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We focus primarily on the insurance needs of senior citizens - Medicare Supplements (Medigap), Medicare Advantage, Prescription Drugs, Dental, Vision, Life, and Final Expense. We concentrate our expertise on the issues facing seniors.>
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Frank and Janet
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The Basics of Health Care for Medicare-Eligible Individuals
Overview of Health Care Alternatives: When you become eligible for Medicare you will have two fundamental alternatives for your health care coverage, which will result in some new ID cards in your wallet or purse. On the one hand, you can end up with separate ID cards for your Medicare, your Medicare Supplement (Medigap), and your Prescription Drug coverages (three cards). On the other hand, you can end up with one ID card for your Medicare Advantage coverage. This is a major decision, and the choice is yours - but, we recommend that you talk with us about the differences. Here is a diagram that may help you understand the Alternatives that are currently available.
Medicare at a Glance: - "Medicare" is the federaly defined and controlled program that provides basic health insurance for individuals who are: (A) 65 years of age or older, (B) under 65 years of age with certain disabilities, or (C) of any age with end-stage renel disease (ESRD: Permanent kidney failure required dialysis or a kidney transplant). Medicare consists of four PARTS. For more about the different PARTS of Medicare, view the accordion below.
The Four PARTS of Medicare
Medicare Part A (Hospital Insurance)
- Part A is generally free for most beneficiaries. Part A addresses the cost of inpatient care in a hospital or skilled nursing facility, but not long-term care in a nursing home. It also covers hospice and some home health care.
- Subject to (A) Hospital Deductible (For 2017: $1,316.00), (B) Hospital Coinsurance (Days 61 - 90: $329.00. Days 91 - 150: $658.00 (lifetime resereve)), and (C) Skilled Nursing Facility Care Coinsurance (Days 21 - 100: $164.50).
Medicare Part B (Medical Insurance)
- Part B of Medicare has a monthly premium. For individuals who have had Medicare Part B active before 2016, the premium in 2017 is about $109.00 (depending on SSA Benefit amount). For individuals starting Part B after 2015, the premium is $134.00. Each year the Center for Medicare & Medicaid Services (CMS) sets new deductibles and premiums for Medicare Parts A & B (including the exta costs to those individuals with higher incomes). While Part A is typically free, the cost of Part B helps cover doctor's services, medical tests, hospital outpatient care, some home health care and durable medical equipment. Coverage includes many preventive services, such as flu shots and mammograms. It also covers a few medications, such as shots you get in a doctor's office and certain oral cancer drugs.
- Subject to an annual deductible (For 2017: $183.00).
Medicare Part C (Medicare Advantage Plans)
- This is an alternative to original Medicare (Parts A & B). Medicare Advantage plans are administered by private insurance companies and cover the same benefits as Parts A, B, and usually D. Some also include extra benefits, such as dental, vision or hearing services.
- Typically there are a number of restrictions with a Medicare Advantage plan; PPO / HMO networks, geographical service areas, etc.
- If an individual elects to utilize a Medicare Advantage plan, that individual cannot enroll in a Medicare Supplement plan.
- Monthly premiums are typically the same or slightly more than Medicare Part B premiums. However, because of deductibles, coinsurance factors and copays, savings can be temporary or nonexistent if services are required.
Medicare Part D (Prescription Drug Coverage)
- Medicare drug plans are managed by private insurance companies in partnerships with pharmacies. This coverage can be obtained two ways: If you have original Medicare (Parts A & B), you can enroll in a separate Part D plan. If you have a Medicare Advantage plan (Part C), prescription drug coverage often is included in the package.
- Monthly premiums and price lists (called Formularies) differ with each plan. The least expensive monthly premium is often not the most cost effective alternative.
- There is a penalty for not enrolling in a Part D plan when you are first eligible to do so.
- Acceptable alternatives are available through the VA, or through an employer's or union's insurance plan.
The Decision Process: - Which PARTS and PLANS are best for you? That depends! For a detailed discussion about the factors that should be considered, read this Decision Process Document
Select Medicare Supplement Insurance Companies
The following insurance companies have been carefully selected because of their competitive rates. Over time, the list expands and contracts as new carriers enter the market and as existing carriers' rates become non-competitive.
AARP-UnitedHealthcare -- Aetna Health and Life -- Bankers Fidelity -- Blue Cross Blue Shield
Cigna Health and Life -- Combined Insurance -- Companion Life
Central States Indemnity -- Equitable Life & Casualty -- Heartland National
Individual Assurance -- Liberty Bankers -- Manhattan Life -- Mutual of Omaha
New Era -- Oxford Life -- Prosperity -- Sentinel Security
Thrivent Financial -- United American -- Western Catholic Union
Medigap - Medicare Supplements for Eligible Individuals
Medigap at a Glance: - Medicare Supplement, or Medigap, policies are sold by private insurance companies to fill the gaps left uncovered by Original Medicare (PARTS A & B). These PLANS help pay your share (deductibles, coinsurance, copayments) of the costs of Medicare-covered services. For more about Medicare Supplement PLANS, see the in-depth information below. For truly unbiased answers to your senior health issue questions, we encourage you to contact Illinois' Senior Health Insurance Program (SHIP), which is a division of the Illinois Department of Aging. Here is a Brochure and a list of Locations.
Key Factors about Medicare Supplement PLANS
All the Plans are Standardized
- Plans are designated by letters ranging from "A" through "N" and must follow federal and state laws to protect you. The plans are defined at the federal level by the Center for Medicare and Medicaid Services (CMS) and are monitored for compliance by the Illinois Department of Insurance. The most popular Medicare Supplements are Plans F, G and N. Here is an Overview of how these three plans address the charges not covered by Medicare.
- Each standardized Medicare Supplement policy must offer the same basic benefits, no matter which insurance company sells it.
- Cost is usually the only difference between Medicare Supplement policies sold by different insurance companies.
- All policies are "individual" policies - there are no "family" or "group" policies, although a few companies offer a "household" discount if spouses / partners are both enrolled.
- Here is a Chart describing the benefits of all the currently available Medicare Supplement plans, and the most recently published booklet "Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare from CMS."
Enrollment can be Done at Any Time
- Most individuals enroll in a Medicare Supplement plan during their "Open Enrollment" period when they become eligible for Medicare. The Open Enrollment period is defined as a six-month period starting on the Effective Date of Medicare Part B. During the Open Enrollment period, individuals can apply for any plan at the lowest premium rate from any insurance company, without consideration of medical issues or tobacco use.
- Some individuals enroll in a Medicare Supplement plan during a "Guaranteed Issue" period. These are special time periods that exist under special circustances.
- Individuals can apply for Medicare Supplemente coverage at any time during the year. If the individual is not in an Open Enrollment or Guaranteed Issue period, medical questions may limit which companies will approve an application.
Not All Medical Charges are Covered
- Medicare Supplement Policies address "Approved" charges that are not paid for by Medicare. Not all "medically required" charges are "Approved" as part of the covered charges of Medicare.
- Some examples of medically required charges that are not covered by Medicare (and by extension, are not covered by Medicare Supplement policies) include routine Dental, Vision, Hearing, and Long Term Care costs. Other Insurance policies are available for these areas, and are described elsewhere on this web site.
- Other examples of non-covered or partially-covered charges include Chiropractic services, physical therapy, third surgical opinions, health care needed when traveling outside the United States, etc. For more details, review the most recently published official U.S. Government Medicare Handbook "Medicare & You".
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