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A Brief History of Medicare and Medicaid

Groom yourself for trivia night with this brief history of Medicare and Medicaid.  Original Medicare, or what is known as Parts A and B (hospital and medical coverage), is a relatively new feature in the United States. It was signed into law on July 30, 1965, by then-President Lyndon B. Johnson. Of course, changes have been made since then. In 1972, Medicare was expanded to cover people with disabilities, people with end-stage disease requiring dialysis or kidney transplants, and people who select Medicare at age 65 and older. Additionally, more benefits, such as prescription drug benefits have been added.

At first, Medicaid only offered benefits to a certain group of people: those receiving cash assistance from the federal government. Medicaid has changed since then as well, as a much larger group is covered now, including: low-income families, pregnant women, people with disabilities regardless of age, and those who need long-term care. Under these newer laws, states have the responsibility and ability to change their Medicaid programs to best cover their vulnerable populations, thus ensuring the best use of the federal and tax dollars that cover Medicaid.

Y2K Changes

In 2003, the largest change was made to the Medicare and Medicaid program in over 38 years: The Medicare Prescription Drug Improvement and Modernization Act. Medicare Advantage Plans or Medicare Part C became available under the MMA. This act also expanded Medicare to include an optional prescription drug benefit, known as Part D. Medicare Part D went into effect in 2006.

Since 2006, the largest change to Medicare and Medicaid has come with the Affordable Care Act (ACA).    ACA  created the health insurance marketplace and subsidized health insurance for millions of Americans. As a result, Medicare and Medicaid have been able to better coordinate how they cover their beneficiaries and provide quality health care services.

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What is the difference between Part A and Part B of Medicare?

In order to help your clients choose the best healthcare coverage for their needs, you need to understand the coverage they already have: Medicare. There are four parts to Medicare.  Medicare Part A and Medicare Part B are provided by Medicare.  Those two parts make up the original federal health program.  Part A and B are referred to as Original Medicare.  Remember, Medicare is a US government entity.   Part C and Part D are purchased from private insurance carriers.

Medicare Part A is hospital insurance.  As hospital insurance,  Part A generally covers the following.

• Inpatient hospital stays

• Prescription drugs administered in the hospital

• Skilled nursing facility stays

• Mental health inpatient stays

• Hospice care

• Limited or temporary home health care

Medicare Part B is medical insurance.  As medical insurance, Part B generally covers the following.

• Annual wellness exams

• Doctor and specialist visits

• Preventative services (flu shots, etc.)

• Bone mass measurements

• Tests and screenings for certain diseases

• CPAP machines for sleep apnea

• Certain diabetes equipment and supplies

• Limited home health visits

• Durable medical equipment (walkers, wheelchairs, etc.)

This is not a complete list of the medical services covered by Medicare Part B.  However, it is a starting point to help your clients understand where their gaps in coverage are and how to choose supplemental insurance to address those gaps.

Click here to learn how to compare Medicare Advantage plans.

Click here to learn how to compare Medicare Supplement plans.

Medicare Advantage and Supplemental Sales Video

Does Medicare Cover Hospice ?

How to Qualify for Hospice Care:

Your clients qualify for hospice care if they have Medicare Part A and meet the following conditions:

• A hospice doctor (and regular doctor if applicable) certifies that they are terminally ill (defined as a life expectancy of 6 months or less).

• They accept comfort care (palliative care) instead of continuing to try to cure the illness.

• They sign a statement choosing hospice care instead of other Medicare-covered treatments for the terminal illness and related conditions.

Your clients can usually get Medicare-certified hospice care in their home or other live-in facility like a nursing home. They can also get hospice care in an inpatient hospice facility.

What is Hospice Care:

Depending on the terminal illness and related conditions, a hospice team will create a plan of care that can include any/all of these services:

• Doctors’ services.

• Nursing and medical services.

• Equipment for pain relief and symptom management.

• Medical supplies.

• Drugs for pain and symptom management.

• Aide and homemaker services.

• Physical therapy services.

• Occupational therapy services.

• Speech-language pathology services.

• Social services.

• Dietary counseling.

• Spiritual and grief counseling for you and your family.

• Short-term inpatient care for pain and symptom management.

• Inpatient respite care, which is care provided in a Medicare-approved facility (like an inpatient facility, hospital, or nursing home), so that the usual caregiver can rest.

• Any other services Medicare covers as the hospice team recommends.

What it Costs in Medicare:

• Clients pay nothing for hospice care.

• Clients pay a copayment of up to $5 for each prescription for outpatient drugs for pain and symptom management. In the case the hospice benefit doesn’t cover a drug, the client’s hospice provider should contact the Medicare plan to see if Part D covers it.

• The client may have to pay for board if they live in a facility and choose to get hospice care.

• To learn more about what is covered under Hospice Care, visit Hospice Care Coverage.

Find out what Medicare covers

Click  here to learn 5 things Medicare does not cover.

If you would like more information on Medicare enrollment, you can find it at Medicare.gov.

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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.

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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)