3 Questions and Answers About 2017 Medicare Part A

Medicare-Card

When you’re first eligible for Medicare, usually when you turn 65, you have an Initial Enrollment Period to sign up for Part A.   You usually don’t pay a monthly premium for Medicare Part A (Hospital Coverage) if you or your spouse paid Medicare taxes for 40 quarters, or ten years, while working. This is sometimes called “premium-free Part A.” Most people get premium-free Part A.

In general Medicare Part A covers

  • Hospital care
  • Skilled Nursing Facility Care
  • Hospice
  • Home Health Services
  • Nursing Home Care (as long as custodial long-term-care isn’t the only care.)

If you are admitted as an inpatient in a hospital or Skilled Nursing Facility Medicare Part A pays for your stay after a $1,316 deductible that must be met for each hospital benefit period.

Q1: So what’s a hospital benefit period?  

A: This period begins the day you’re admitted as an inpatient in a hospital or Skilled Nursing Facility (SNF) and ends when you haven’t received any inpatient hospital care (or skilled care in a SNF) for 60 consecutive days. For example, you were admitted and released from a hospital on days 1 and 4.  After 60 consecutive days of NOT being in the hospital, that would be day 64, the benefit period ended.  If you were admitted to the hospital of SNF on day 65 a new benefit period would start and, yes, a new $1,316 deductible would apply.

Q2: After the $1,316 deductible, is there a daily copay?

A: The $1,316 deductible covers the first 60 days of hospital confinement cost or 20 days of skilled nursing facility eligible expenses.  After these periods, in patient hospital and skilled nursing facility co-pays apply to hospital stay days 61-150 and skilled nursing facility stay days 21-100. (See below)

2017-A-Chart

Q3: Is there a health plan to help cover those hospital and skilled nursing deductible and daily co-pays?

A:  Yes. A Medicare Supplemental Insurance plan, often known as “MediGap,” can help with the Medicare Part A deductible and daily co-pay expenses.  As a reminder, Medigap policies generally don’t cover long-term care, vision vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

 In New York State, the Department of Financial Services posts the current monthly premiums for Medicare Supplement plans by zip code. Click here or call me at 518-346-2115 for assistance.

Switching Medicare Supplement (Medigap) policies

Reasons Why New Yorkers Switch Their Medigap Policies:

As a reminder, Medicare Supplement, also known as Medigap, are policies designed primarily to supplement (or fill the gap) Medicare benefits. You simply present your red, white and blue Medicare card to the provider or facility along with the Supplement / Medigap card to help with out-of-pocket costs; such as deductible and co-insurance amounts with Original Medicare Part A  and Part B.

Currently, there are 10 standardized Medigap plans, each represented by a letter (A, B, C, D, F, G, K, L, M, N; there’s also a high-deductible version of Plan F). These plans are available in most states.  While premiums will vary from state to state the standardized benefits of each lettered plan remain the same despite the insurance company or location. For example, Plan F benefits are the same in Florida as they are in New York.

Q: Is there an Annual / Open Enrollment Period?

Most people buy their Medicare Supplement / Medigap policy during the six month period after they first enroll in Medicare.   After that, in many states,  Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy.

Q: So How Do New York State Residents Have More Protection?

New York State laws and regulations continue this open enrollment period. A person enrolled in Medicare Parts A and B may purchase a Medigap policy at any time. Insurers may not consider an applicant’s health status, claims experience, or age.  Laws in New York also prohibit insurers from basing Medigap premiums on age and charging a higher premium as they grow older.  Also,

Q: But What About Pre-Existing Conditions; Are They Covered?

Medigap insurers may impose up to a six-month waiting period to be covered for any preexisting conditions a person may have. Federal law and New York State regulation define a preexisting condition as any condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage.

Under New York State regulation, the waiting period may be either reduced or waived entirely, depending upon whether an individual has had previous health insurance coverage. Medigap insurers are required to reduce the preexisting condition waiting period by the number of days an individual was covered under some form of “creditable” coverage so long as there were no breaks in coverage of more than 63 calendar days.   Translation: If you are switching from a “creditable” plan that you have held consecutively for six months, New York regulation requires the new Medicare Supplement / Medigap plan to reduce or waive the six month pre-existing condition waiting period.

Questions about Switching a MediGap Policy?

Please call me at (518) 346-2115 or send a quick note with your contact information and question.

Please visit and follow via Facebook Page. Daniel G. Alcorn, a licensed and independent agent, represents licensed insurance companies in New York and other states.  Dan may receive compensation for individual enrollments in Medicare Advantage, Medicare Supplemental Insurance , Medicare Prescription Drug or Long Term Care plans.

When what we do helps someone… February 2017

…. it’s great to hear results.    Read more of this post

Medicare Part A / B Savings Program

Medicare-Card

 

 

 

 

 

 

Most Medicare beneficiaries pay $0 for the Part A hospitalization benefits if they or their spouse paid Medicare taxes while they worked.

For Part B medical insurance, most people pay the standard $104.90 monthly premium.

helpFor New York State residents meeting certain conditions, a Medicare Savings Program may help pay the Medicare Part A and Medicare Part B premiums, deductibles, coinsurance and copayments.

 

Together with the EPIC Prescription Drug Program,  this New York State Medicare Assistance program can help seniors with the cost of healthcare.  I am available to assist with education and enrollment (518) 346-2115.

Important Links:

red_arrow Download 2014 NY State Medicare Part B assistance Form

red_arrow Visit New York State Department of Health

red_arrow Visit Medicare.gov

Informational Guides to Medicare

Download your own copy of these informational guides from Medicare Made Clear.

Do you have additional questions about Medicare?

There’s a guide for that!

The comprehensive Show Me Guide and the other resources listed below can help.
http://www.medicaremadeclear.com/information/medicare-guides

Contact me with any questions:
http://www.myuhcagent.com/daniel.alcorn

Family Caregivers Kit: 9 Free Publications

helpManage a loved one’s finances and health care with knowledge and confidence.

The Family Caregivers Kit is a collection of publications that help you understand your duties as an agent under a power of attorney, keep track of medications, protect your loved ones from scams, and more.

 

PUBLICATIONS FEATURED IN THE FREE FAMILY CAREGIVERS KIT

( Download Adobe Reader to view these publications.)
  1. Consumer Action Handbook  Family Caregivers Kit -1
  2. Health Scams Family Caregivers Kit -2
  3. Money Smart for Older Adults: Financial Exploitation  Family Caregivers Kit -3
  4. Managing Someone Else’s Money: Fiduciary   Family Caregivers Kit -4
  5. Managing Someone Else’s Money: Court Appointed Guardians Family Caregivers Kit -5
  6. Managing Someone Else’s Money: Representative / VA Fiduciary Family Caregivers Kit -6
  7. Managing Someone Else’s Money: Trustees / Revocable Living Trust Family Caregivers Kit -7
  8. My Medicines  Family Caregivers Kit -8
  9. Use Medicines Wisely  Family Caregivers Kit -9

 As an independent licensed Life, Accident and Health Insurance professional, I represent several insurance companies authorized to conduct business in New York.  For more information about how affordable insurance can protect your assets and provide you greater control over your financial planning, please contact me at (518) 346-2115 for a confidential and complimentary consultation.

"This service is provided by the Consumer Financial Protection Bureau, 
Food and Drug Administration's Office of Women's Health and the 
Federal Citizen Information Center at the General Services Administration."