Paid Advertisement Ask the Medicare Specialist by: Aaron Zolbrod Welcome to Part 2 of the series, "New to Medicare" which I'm writing to help guide those who will soon be going on Medicare Parts, A. B, or both. QUESTION: What does Medicare Parts A and B cost and cover? What are the choices in Medicare Plans? Do they differ as far as coverage, premiums and out of pocket costs, access to doctors and hospitals, and how claims are approved and paid? ANSWER: company must pay their share, while Part B is currently $18.50 The two cholces in Medicare plans o questions asked. Medicare lets the treating physician decide pay more based on their income. and Advantage Plans. Supplements what's medically necessary so Medicare Part A has no cost hook for the other 20%. month. However, some people will are Supplements, aka Medigap. A single person who makes over S87.000 annually and a married couple earning $174,000 are are secondary to Medicare and pay there's no prior authorizations needed. In addition, claims for the portion of the bill Medicare doesn't pick up. Those with charged a higher amount. This is Supplements show two cards at known as IRMAA (Income Related a doctor or hospital. Advantage Medicare covered services are never denied. Medicare Advantage Plan insurance companies make the determination of what is "medically necessary" and require prior authorizations for outpatient surgeries and rehab, MRI's and CT scans, home health care, anda couple other Monthly Adjustment Amount). The more one makes, the higher the cost for Part B, up to $501 per month. Plans are HMO's or PPO's and pay in place of Medicare, Those on Advantage Plans don't show their Medicare card at a doctor or hospital because Medicare longer pays any portion of one's medical bills for those with HMO's or PPO's. What Medicare does instead is pay a private Part A covers two services: inpatient hospitalizations and a stay in a Skilled Nursing Facility (SNF). Those who have Medicare only and no other plan are eMefra $1,484 deductible, as for any hospital admission up to 60 consecutive days. An odd aspect of Medicare is who stayed two days in the hospital pays the same $1.484 as the person who was there for 52. services. Although not a common practice, claims can be denied, and insurance companies can make a insurance company of one'scholce determination that additional days in the hospital or Skilled Nursing approximately Sa00 per month to become the beneficiary's one and only insurance company that point it becomes the private insurance company's job to provide health insurance to that individual and pay claims, minus After 60 days, additional costs are the insured's cost sharing. s it, Facility (SNF) aren't necessary and refuse to pay for them, although these decisions can be appealed. What medical services and supplies are covered are the same with both types of plans billed on a per day basis. Days 6 Advantage Plans are required to cover the same services as Original Which brings us toa couple of through 90 are $371/day and days the biggest differences between 91 through 150, $742. It's quite rare Supplement and Advantage for someone to spend 100 or more Plans premiums and out of days as an inpatient, let alone 60. pocket medical responsibility Medicare and as good or better than Medicare. Most Advantage Plans offer ancillary benefits. which include dental, vision, Over the Counter (OTC) and hearing aid but it does happen. I've had two clients I know of, and I'm sure Supplements generally cost more than Advantage Plans and start between S0 to 885/month over 100 days in the hospital. With for a 65-year old. However, the Medicare only, we're talking about Supplement plans my agency a few others I didn't, who spent allowances, gym memberships, and more that can be very generous and valuable. Supplements do not provide any of these. a total cost upwards of $50,0. recommends eliminate all This alone is why people purchase medical bills except for a $00 either a Supplement or Advantage annual deductible and possibly a couple small co-pays of $20at kind of catastrophic medical bill. the doctor and $50 for a trip to the ER. In addition, Supplements almost always need to be piggy refer to it as inpatient rehab that's backed with a separate Part D needed after lengthy hospital stay, prescription drug plan and most people pay between $7 and $25/ month. Advantage Plans, when chosen wisely, are less expensive. Yet another difference is access to medical providers, Those on Supplements can go to any doctor or hospital in the country that accepts Medicare Assignment and agrees to take them as a Plan. Both protect against this A Skilled Nursing Facility is a short-term nursing home. I often patient. Again, Advantage Plans are HMO's and PPO's, and utilize networks. With and HMO, the insurance company will not pay for services at an out of network provider We almost never advise our cljents except in an emergency You can go out of network with a PP if the provider agrees to accept the insurance. However, costs for the same services at an out of network a bad stroke, a serious injury - The care given is designed to nurse a patient back to health so they can go home and be 100% of the cost for the first 20 days. Days 21- 100 have a liability of $185.50 per day independent again. Medicare pays to spend more than $10/month for a plan and many have premiums $0. However, those who choose Advantage Plans are exposed Part Bcovers outpatients services to higher out of pocket imedical of can be much higher. doctor visits, testing such as costs, up to 87,550 per year. Co-pays In the coming weeks, I will get more in depth of the differences, pros and cons, and who I feel is best to choose a Supplement and Advantage Plan. blood work, X-Rays and CT scans: or comsurance (a peroentage surgeries such as Cataract, Carpal of the total bill) can range from $5 for a PCP visit, to $200 for an MRI or CT scan, to thousands for Chemotherapy or a lengthy stay in radiation; emergency room visits: a SNE Almost all Advantage Plans include Part D. so the purchase of an additional prescription plan Tunnel, a Colonoscopy ete, that people have performed and are home the same day: Chemo and and rehab Medical equipment and supplies are also covered under Part Band include oxygen, wheelchairs, crutches, CPap etc. Anything covered under I is paid for by Medicare at 80. putting the beneficiary on the If you would like to read previous columns in the series, listen or watch the podcast and webcast versions, please visit our website. With questions or to set up a no cost consultation with one of our licensed agents, please give one of our offices a call or feel free to email me personally at aarone GetYourBestPlan.com. isn't necessary How elaims are approved and paid also differ. Supplement insurance companies actually have no say in what's covered If Medicare pays, the insuranoe machines, diabetic supart B 724-603-3403 The Health Insurance Store.e Connellsville 412-349-8818 Forest Hills Email your question to: aaron@getyourbestplan.com www.getyourbestplan.com No-cost, unbiased Medicare plan review and consultation with local, licensed agents Paid Advertisement Ask the Medicare Specialist by: Aaron Zolbrod Welcome to Part 2 of the series, "New to Medicare" which I'm writing to help guide those who will soon be going on Medicare Parts, A. B, or both. QUESTION: What does Medicare Parts A and B cost and cover? What are the choices in Medicare Plans? Do they differ as far as coverage, premiums and out of pocket costs, access to doctors and hospitals, and how claims are approved and paid? ANSWER: company must pay their share, while Part B is currently $18.50 The two cholces in Medicare plans o questions asked. Medicare lets the treating physician decide pay more based on their income. and Advantage Plans. Supplements what's medically necessary so Medicare Part A has no cost hook for the other 20%. month. However, some people will are Supplements, aka Medigap. A single person who makes over S87.000 annually and a married couple earning $174,000 are are secondary to Medicare and pay there's no prior authorizations needed. In addition, claims for the portion of the bill Medicare doesn't pick up. Those with charged a higher amount. This is Supplements show two cards at known as IRMAA (Income Related a doctor or hospital. Advantage Medicare covered services are never denied. Medicare Advantage Plan insurance companies make the determination of what is "medically necessary" and require prior authorizations for outpatient surgeries and rehab, MRI's and CT scans, home health care, anda couple other Monthly Adjustment Amount). The more one makes, the higher the cost for Part B, up to $501 per month. Plans are HMO's or PPO's and pay in place of Medicare, Those on Advantage Plans don't show their Medicare card at a doctor or hospital because Medicare longer pays any portion of one's medical bills for those with HMO's or PPO's. What Medicare does instead is pay a private Part A covers two services: inpatient hospitalizations and a stay in a Skilled Nursing Facility (SNF). Those who have Medicare only and no other plan are eMefra $1,484 deductible, as for any hospital admission up to 60 consecutive days. An odd aspect of Medicare is who stayed two days in the hospital pays the same $1.484 as the person who was there for 52. services. Although not a common practice, claims can be denied, and insurance companies can make a insurance company of one'scholce determination that additional days in the hospital or Skilled Nursing approximately Sa00 per month to become the beneficiary's one and only insurance company that point it becomes the private insurance company's job to provide health insurance to that individual and pay claims, minus After 60 days, additional costs are the insured's cost sharing. s it, Facility (SNF) aren't necessary and refuse to pay for them, although these decisions can be appealed. What medical services and supplies are covered are the same with both types of plans billed on a per day basis. Days 6 Advantage Plans are required to cover the same services as Original Which brings us toa couple of through 90 are $371/day and days the biggest differences between 91 through 150, $742. It's quite rare Supplement and Advantage for someone to spend 100 or more Plans premiums and out of days as an inpatient, let alone 60. pocket medical responsibility Medicare and as good or better than Medicare. Most Advantage Plans offer ancillary benefits. which include dental, vision, Over the Counter (OTC) and hearing aid but it does happen. I've had two clients I know of, and I'm sure Supplements generally cost more than Advantage Plans and start between S0 to 885/month over 100 days in the hospital. With for a 65-year old. However, the Medicare only, we're talking about Supplement plans my agency a few others I didn't, who spent allowances, gym memberships, and more that can be very generous and valuable. Supplements do not provide any of these. a total cost upwards of $50,0. recommends eliminate all This alone is why people purchase medical bills except for a $00 either a Supplement or Advantage annual deductible and possibly a couple small co-pays of $20at kind of catastrophic medical bill. the doctor and $50 for a trip to the ER. In addition, Supplements almost always need to be piggy refer to it as inpatient rehab that's backed with a separate Part D needed after lengthy hospital stay, prescription drug plan and most people pay between $7 and $25/ month. Advantage Plans, when chosen wisely, are less expensive. Yet another difference is access to medical providers, Those on Supplements can go to any doctor or hospital in the country that accepts Medicare Assignment and agrees to take them as a Plan. Both protect against this A Skilled Nursing Facility is a short-term nursing home. I often patient. Again, Advantage Plans are HMO's and PPO's, and utilize networks. With and HMO, the insurance company will not pay for services at an out of network provider We almost never advise our cljents except in an emergency You can go out of network with a PP if the provider agrees to accept the insurance. However, costs for the same services at an out of network a bad stroke, a serious injury - The care given is designed to nurse a patient back to health so they can go home and be 100% of the cost for the first 20 days. Days 21- 100 have a liability of $185.50 per day independent again. Medicare pays to spend more than $10/month for a plan and many have premiums $0. However, those who choose Advantage Plans are exposed Part Bcovers outpatients services to higher out of pocket imedical of can be much higher. doctor visits, testing such as costs, up to 87,550 per year. Co-pays In the coming weeks, I will get more in depth of the differences, pros and cons, and who I feel is best to choose a Supplement and Advantage Plan. blood work, X-Rays and CT scans: or comsurance (a peroentage surgeries such as Cataract, Carpal of the total bill) can range from $5 for a PCP visit, to $200 for an MRI or CT scan, to thousands for Chemotherapy or a lengthy stay in radiation; emergency room visits: a SNE Almost all Advantage Plans include Part D. so the purchase of an additional prescription plan Tunnel, a Colonoscopy ete, that people have performed and are home the same day: Chemo and and rehab Medical equipment and supplies are also covered under Part Band include oxygen, wheelchairs, crutches, CPap etc. Anything covered under I is paid for by Medicare at 80. putting the beneficiary on the If you would like to read previous columns in the series, listen or watch the podcast and webcast versions, please visit our website. With questions or to set up a no cost consultation with one of our licensed agents, please give one of our offices a call or feel free to email me personally at aarone GetYourBestPlan.com. isn't necessary How elaims are approved and paid also differ. Supplement insurance companies actually have no say in what's covered If Medicare pays, the insuranoe machines, diabetic supart B 724-603-3403 The Health Insurance Store.e Connellsville 412-349-8818 Forest Hills Email your question to: aaron@getyourbestplan.com www.getyourbestplan.com No-cost, unbiased Medicare plan review and consultation with local, licensed agents