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What will Medicare pay for

Because many people are unsure what will Medicare pay for, we are providing a quick summary of the parts of Medicare and what they cover.

Medicare is a federal health insurance program.  It provides coverage to people who are either 65 years or older, people with disabilities, and those with end-stage renal disease.  There are four parts of Medicare plans: Part A, Part B and Part C, as well as Part D.

What Medicare Part A pays for:

Part A or hospital insurance covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care services.

1. Inpatient Hospital Stays: Part A pays for the cost of a semi-private room, meals, nursing care, and other hospital services and supplies. It also covers the cost of surgeries, anesthesia, and other medically necessary procedures.
2. Skilled Nursing Facility Care: If you need to stay in a skilled nursing facility for a short period after being discharged from the hospital, Part A covers the cost of a semi-private room, meals, nursing care, and therapy.
3. Hospice Care: If you have a terminal illness, Part A covers hospice care services, including pain relief, counseling, and medical care.
4. Home Health Care: Part A covers some home health care services if you are homebound and need skilled nursing care, physical therapy, or speech-language pathology services.

What Medicare Part B pays for:

Part B is also called medical insurance. It covers medically necessary services and preventive services that are not covered by Part A. Here’s what Part B pays for:

1. Doctor’s Services: This includes office visits, consultations, and surgical procedures.
2. Outpatient Services: Part B covers services that include diagnostic tests, laboratory services, and imaging tests.
3. Preventive Services: These services  include flu shots, cancer screenings, and annual wellness visits.
4. Durable Medical Equipment: Beneficiaries receive coverage for the purchase of durable medical equipment, including wheelchairs, walkers, and oxygen equipment.
5. Ambulance Services are covered if they are medically necessary.

What Medicare Part C pays for:

Medicare Part C or Medicare Advantage (MA plans). It is an alternative to Original Medicare, which includes Part A and Part B. Medicare Advantage plans are offered by private insurance companies. In most cases, they include additional benefits, such as vision, dental, and hearing coverage. Medicare Advantage plans must cover all the services that Original Medicare covers, but the cost-sharing and rules may be different.

What Medicare Part D pays for:

Some people refer to these plans as prescription drug coverage.  Private insurance companies offer this coverage to cover the cost of prescription drugs.  Part D plans typically have a formulary, which is a list of drugs that the plan covers. The cost-sharing and rules for Part D plans may vary.

In conclusion, Medicare covers a wide range of medical services.  This includes hospital stays, doctor’s visits, preventive care, medical equipment, and prescription drugs. Understanding what each part of Medicare covers can help you make informed decisions about your healthcare needs.

Medicare agents; find out what Crowe and Associates has to offer 

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Aetna Medicare Over The Counter Catalog 2019

The Aetna Medicare Over The Counter (OTC) Catalog 2019 is now available.

To view an updated post – Click here for details

Carriers now offer a Medicare over the counter (OTC) benefit  to their members.  In addition to your plan benefits, over the counter benefits  defray some of the cost of necessary healthcare items not covered as a medical or pharmaceutical expense.

Aetna Medicare offers members an Over-The-Counter benefit.

This benefit pays up to a $25 maximum amount every month for over the counter  (OTC) items.  The catalog lists eligible items.    Only items listed in the OTC catalog are covered by the over the counter benefit.  Many products you would normally purchase from a drugstore are critical to a healthy lifestyle.  These items may include non-prescription medications, vitamins,  and eye care.  In addition to these you can purchase every day items that impact your health, like hand sanitizer.  This benefit allows you to purchase these items from the catalog at no cost to you.  Accordingly, the cost of these items is part of your Medicare OTC benefit.

1. The over the counter benefit in 2019 is up to $25/member every month.  However, there are rules with regard to how items must be ordered.
2. The over the counter  benefit is included with all Aetna Medicare Advantage plans in 2019.
3. You must order from the catalog or online. Items purchased from a retail store are not part of the benefit.
4. Because this is a “use it or lose it” benefit,  benefit dollars do not carry over month to month.  Therefore,  be sure to check the catalog each months for items you will need.
5. You cannot use your CVS Extra Care card toward these purchases.
6. Free shipping!  There are no shipping or handling fees.
7. Orders typically take two weeks to arrive.  Plan ahead for adequate supplies.

You can place an Over the Counter order 2 ways.  You can order either by phone at 1-888-628-2770 Monday through Friday 9:00am to 8:00pm EST, or you can order online at visit:myorder.otchs.com.

Choosing a Medicare plan can be confusing!  Remember, that is what we specialize in!    If you still need help determining which Medicare option will suit you best,  call us at 203-796-5403 and schedule an appointment today.

Agents can click for a Medicare Scope of Appointment 

Applying for Medicare in Connecticut

This post will try and give you some help when you are applying for Medicare in Connecticut.  This can be overwhelming for some people.  We want to make it easy for you.  If you are 65 years old, or are under 65 and qualify for Medicare because of a disability or other special circumstance, you are eligible for Medicare.  (Note:  You must be a US citizen or a legal resident for at least 5 consecutive years to be eligible for Medicare.)

Apply for Medicare can be done online by CLICKING HERE.  You can also enroll by phone at 1-800-MEDICARE.  Or, you can enroll in person at your local social security office.  You can call 1-800-772-1213 for help locating your local social security office.

Click here for more details regarding choosing a Medicare plan in CT.

Medigap Plans CT

Medigap plans Ct are also called Medicare supplement plans.   They provides coverage for these “gaps” in your Medicare coverage and can save you money.  Medigap plans are not Medicare Advantage plans rather, they provide coverage after Original Medicare A and B benefits pay.  As a result, it is important to note that Medigap plans will only cover services that are approved by Medicare. They will not help cover costs that Medicare does not allow/approve.

Access all Medigap plans CT (Medicare supplement plans) with this link.  Site will show you all plans and rates in CT.

Are you a broker looking to sell Medigap plans?  If so, click here to learn more about Medigap sales.

Medicare supplemental plans are offered by private insurance companies.  These plans help to pay the ‘gap’ between costs covered by original Medicare and your out of pocket costs.  Medigap plans are regulated by national and state governments and therefore benefits are generally the same, regardless of the insurance company.   For example, Plan A has the same benefits regardless of the company you purchase it from.  As a result, rates and value add benefits are the only difference from company to company.

Medigap plans do not cover medication expenses.  If you enroll in a Medigap plan, you should also consider a Medicare Part D (prescription drug) plan.  The rule is different for drugs under medicare part B. As a result, it is important to pick the right part D drug plan.  The pharmacy you like to use and the specific prescriptions you take make all the difference when selecting a drug plan.  Call our office to learn more or use the CMS drug plan finder tool. 

Want to learn more about the differences between a Medigap plan and a Medicare Advantage plan? Click here to learn about all your medicare options.

We are one of Connecticut’s leading Medicare brokerage firms.  Please call us at 203-796-5403 or email us at edward@croweandassociates.com if you have questions.  Better yet, we can set a time to sit face to face and discuss all of your options.  If you aren’t able to travel to our office, we will gladly come to you.

What is Medicare?

This blog will attempt to answer “what is Medicare?” by  providing a basic understanding of the Medicare program and how it works. In addition, it will detail the other parts of Medicare such as C and D.  First of all lets start with the official definition:   Medicare is the federal health insurance program for people who are 65 or older. It is also for certain younger people with disabilities and with End-Stage Renal Disease.  Most people are eligible for Medicare at age 65.

Medicare is made up of four components which can cause confusion.  Original Medicare (Red, White and Blue care with a Medicare ID on it) is Medical coverage with parts A and B.    This is what provides basic medical coverage for those on the program.   Medicare Part C is different than Original Medicare.   Part C is a Medicare Advantage Plan and is something a member can enroll in if they want.  Medicare Part C replaces Medicare A and B for those that enroll in it.   Another part of Medicare is part D which is prescription drug coverage (Also called a PDP). You can enroll in Medicare part D using a stand alone drug plan or access Medicare part D through the drug benefits on an Advantage plan.

Medicare Part A (Hospital Coverage)

Medicare Part B (Medical Coverage)

Medicare Part C (Medicare Advantage Plans)

Medicare Part D (prescription drug coverage)

Medicare Advantage Plans

Medicare Advantage Plans are managed health programs that serve as a substitute for both “Original Medicare” Part A and B benefits. There are a number of types of Advantage plans.  The majority are either HMO or PPO plans. Medicare Part A provides payments for in-patient hospital services and stays. Part B provides coveage for outpatient services.  Doctors visits, lab work, scans and x-rays all fall under part B.  Original Medicare claims are processed through the Centers for Medicare and Medicaid Services (CMS). Medicare Advantage plans are offered by commercial insurance companies. They receive compensation from the federal government, to provide all Part A and B benefits to enrollees, but do not pay claims through the CMS.

Most Medicare Advantage plans (sometimes referred to as “Part C”) include the Part D prescription drug benefits, and are known as a Medicare Advantage Prescription Drug plan (MAPD). The government makes seperate payments to the plans offering drug benefits with the advantage plan. Medicare pays the insurance company a set amount every month for members enrolled in the plans.

Medicare Advantage plans

must offer a benefit that is at least equal to Medicare’s and covers what Original Medicare covers. They do not have to cover every benefit in the same way. Plans that require higher out-of-pocket costs than Medicare for some benefits,  can balance it out by offering lower copayments for doctor visits or other benefits.  CMS limits how much the Medicare Advantage plans can vary from benefits under Original Medicare. Many plans offer benefits which are not covered by Original Medicare.  They do this as a value added benefit to entice more people to enroll in the plan.

All Medicare Advantage plans must have out of pockets maximums for medical services.

The limit for 2016 is $6,700 medical out of pocket.  This applies to in-network services only. Once the out of pocket maximum is obtained, the plan will pay all additional costs. This assumes the services received are in network.  Medicare advantage plan have networks. This means the enrollee must use in network doctors to be covered.  There are exceptions to this such as with a PPO plan.

Other ways to get care out of network would be for an emergency or urgent care situation. Enrolling in a PPO plan provides the ability to go out of network. PPO plans permit a subscriber to use any physician or hospital, but at a somewhat higher expense. Certain PPO plans can lead to much higher costs for going out of network.  The combined out of pocket max goes up to $10,000 on a PPO.  The total is for in and out of network usage.

People can enroll in a Medicare Advantage plan

when first eligilble for Medicare A and B.  They must enroll in A and B prior to enrolling in an advantage plan.  Under most situations, the member can change plans every January during AEP. There are exceptions to this rule however. Many states have multiple Advantage plans offered by various companies.  Some states have over 20 different plans to choose from.  Companies will also offer plans by county.  They may offer a plan in one county but not another within the same state. 

People with low medical utilization tend to migrate towards advantage plans.  If someone is going to the doctor a few times a year on average, they tend to look at the low Advantage premiums as a way to save money. Those with higher medical utilization will have a tendency to go with a Medicare supplement plan of some type.  Supplements tend to have higher premiums and less out of pocket costs which appeals to someone utilizing care more often.  Supplements are also attractive to those that do not want to abide by a network of doctors.  Others tend to go with a supplement to avoid the need for prior authorization which is required on advantage plans.

Trial Right–

Medicare Advantage trial rights are rules that allow someone to switch out of their advantage plan. There are two cases in which a trial right is created.

• Taking an advantage plan when first eligible for Medicare.  A trial right is created allowing the member to change back to Original Medicare any time in the first 12 months.  They can go to Original Medicare with a supplement and/or Rx plan the first of any month
• Taking an advantage plan for the first time. If someone is taking an Advantage plan for the first time. (Even if they have been on a supplement previously). They will have a trial right for the first year they are in the advantage plan. This would allow them to change to a supplement and/or drug plan

AEP- At this time you can change your plan (Advantage to supplement or supplement to advantage) every January 1st during AEP.  At this time someone can make any change they would like. Some states will underwrite a move to a supplement however.

MADP- During this period, a person may leave an advantage plan and go back to Original Medicare.   MADP runs from  January 1 through February 14th every year.  They can also enroll in a supplement and/or Rx plan if they would like.

SEP- A Special Election Period allows someone to make a change outside of AEP.  Certain circumstances will create a SEP.  Moving outside the plan service area, qualifying for extra help, lose of employer coverage.  These are all examples that would create a special election.

Additional Resources:

 Medicare Basics Video – Click here

 For Medicare Advantage Basics Video Click

Click for Medicare Supplement Basics Video

Medicare Information for state of Connecticut

Medicare Part B Coverage

Medicare Part B coverage is medical insurance.  Part B covers doctor visits.  It also covers well visits.  Coverage for medically necessary services and supplies is provided. This coverage includes any service or supply that you require for either diagnosis and or treatment of a medical condition. Part B also covers outpatient services.  Covered services include those provided by either a hospital, doctor’s office, clinic or other health care facility.

Medicare Part B also covers many preventive services to prevent illness or detect them at an early stage.  Together,  Parts A and Part B are known as Original Medicare.

Medicare Part B benefits

Medical services and supplies covered by Medicare Part B include (but may not be limited to):

• Doctor’s visits,
• Urgent care visits,
• Laboratory tests,
• X-rays,
• Emergency ambulance services,
• Mental health services, and
• Durable medical equipment.
• Preventive services, such as pap tests, flu shots, and screenings.
• Rehabilitative services, including physical therapy, occupational therapy, as well as speech-language pathology services.

Part B has a monthly premium associated with it.  The monthly premium is $104.90 in 2016.  If you get either Social Security, Railroad Retirement Board, or Office of Personnel Management benefits, your Part B premium will be automatically deducted from your benefit payment. If you don’t get these benefit payments, you’ll get a bill.   Note:   If you did no take Part B when you were first eligible, the cost of Part B will go up 10% for each full 12-month period that you  could have had Part B but didn’t sign up for it, except in special cases. You will have to pay this penalty as long as you have Part B.

Click here to learn how and when to enroll in Medicare.

Are you ready to sign up for Medicare?  You can sign up online.  Click here to enroll.

We are one of  the Northeast’s leading Medicare expert brokerages.  We do not charge consultation fees.  Feel free to contact the office at 203-796-5403 if you have questions.

Click here for a free personalized Medicare quote.

Interested in getting a home or auto quote?  We can help with that as well.  Email us at Admin@CroweAndAssociates.com.  We will send you a personal online link to enter your info and request a no obligation quote.

 What is Medicare Part A Coverage?

Medicare Part A coverage is hospital care coverage.  This plan covers both lab tests and surgeries.  Doctor care during the stay is also covered.  There is also coverage for supplies like wheelchairs and walkers when they are medically necessary to treat either a disease or a condition.  Part A covers in-patient hospital stays.  These plans also cover care in a skilled nursing facility or nursing home care as well as Hospice care and some home health services.  Note:  Part A will cover nursing home care for medical purposes.  Medicare will not cover the expense if custodial care is the only care necessary.

Part A includes benefits for hospital expenses.

Other expenses part A covers are, a semi-private room and meals as well as medications.  There is also coverage provided for nursing services and other supplies from the hospital.  Part A benefits will cover home health care services when deemed medically necessary.  Your doctor must order home health services in order for this expense to gain approval. Skilled nursing facility (SNF) stays coverage will only receive approval by Part A after a qualifying hospital inpatient stay for a related illness or injury. To qualify for SNF care, the hospital stay must be a minimum of three days.  A qualified stay begins on the day you are admitted. The day the hospital dischares you does not count toward the 3 day requirement.  Patients can be kept for observation.  Time spent under observation is considered outpatient.  This time does not count towards your qualifying stay.

If your doctor has certified that you have a terminal illness, you may be eligible for hospice care coverage.   Your doctor will need to determine a 6 month or less life expectancy.  In hospice care, the focus is on palliative care.  Hospice focus is not cure.  The goal is to relieve pain and make the patient as comfortable as possible.

Click here to learn how and when to enroll in Medicare.

Click here for more information regarding Medicare Part A  benefit coverage.

Connecticut residents looking to compare plan options can click here for more details about plans available.  If you still have questions or would like to set an appointment, please call the office at 203-796-5403.  In fact, we are leading Medicare experts in CT and are here to help.  We do not charge for our consultation services.

Click here for a no cost personal and confidential Medicare quote.

Original Medicare Enrollment

Original Medicare Enrollment in parts A and B is automatic for those drawing Social Security.   Those people who are not that are not will need to enroll.

If you’re already collecting Railroad Retirement Board or Social Security retirement benefits when you turn 65, you will automatically be enrolled Medicare Part A .  If you are under 65 and you receive Social Security or Railroad Retirement Board disability benefits, you will automatically be enrolled in Medicare Part A and Part B after 24 months of disability benefits.

You will need to sign up for Medicare part B, if  you are not receiving retirement benefits before age 65 or  if you qualify for Medicare through disability. Please note, you can sign up during your Initial Enrollment Period (IEP). This is the seven-month enrollment period that begins three months before you turn 65.  This enrollment period includes the month you turn 65, and ends three months later.

Click here to visit the Medicare.gov site to learn details.

CLICK HERE TO REQUEST MEDICARE QUOTE INFORMATION.

Still have questions?  We are Medicare specialists.  Please call if you have questions or need help navigating the Medicare enrollment process.  You can either call the office at 203-796-5403 or email us at admin@croweandassociates.com.

We are a full-service brokerage and offer clients not only guidance with Medicare, but all health plan needs.  We offer dental insurance, both long and short term care policies.  Crowe and Asscoiates can help with estate planning by offering several types of life insurance as well as investment opportunities.