Solutions for Seniors

2016 & 2017 Changes:

With the full implementation of the Affordable Care Act in 2013 we will see some changes with the Medicare medical and prescription plans.

- Premiums, deductibles, copays, and out of pocket maximums may increase with some of the Medicare Advantage plans. There continues to be standard premium increases with the Medicare Supplement (Medi-Gap) plans.

- Increase of the Part D prescription deductible to $400 (2017) and was $360 (2016). Many preferred generics at zero copay remain.

- Reduction in benefits - such as copay increases on doctor visits, hospital admission fees, outpatient services, skilled nursing, and durable equipment copay changed to coinsurance.

- Reduction in the number of physicians servicing Medicare eligible members.

 

What is Medicare:

Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with permanent kidney failure (also known as End-Stage Renal Disease or ESRD). Medicare covers many health care services and supplies, but there are many costs (gaps) it does not cover. 2

Different parts of Medicare:

- Part A (hospital insurance) - helps covers inpatient care in hospital and helps cover skilled nursing facilities, home health, and hospice care.  The monthly premium is zero for most members if they have paid into Social Security.
- Part B (medical Insurance) - helps covers doctor’s services and outpatient care, other medical services that Part A does not cover (like physical and occupational therapists), and some home health care. The monthly premium for this benefit is $134 for 2017 and increases approximately 5% every year.
- Part C (Medicare Advantage Plans) – health coverage options (like PPOs and HMOs) run by private companies approved by and under contract with Medicare.  Includes Part A and Part B, and usually includes other coverage like prescription drugs.
- Part D (Medicare prescription drug coverage) – a prescription drug option run by private insurance companies approved by and under contract with Medicare

We know that Medicare, with all its “parts” can get somewhat confusing. On top of that, when it comes time to choose a Medicare Advantage or Supplement plan that is right for you, the possibilities can seem endless. It is important to review your health care needs every year. If you are dissatisfied with your current plan’s cost and coverage or customer services you have options for change.

If you are just starting to investigate senior plans or have questions about your current coverage please call us or Contact Us if you would like to discuss your options.

Deductibles:

2017 Part A $1316 Part B $183

2016 Part A $1288 Part B $166

2015 Part A $1260 Part B $147

Eligibility:

Enrolled in Medicare A & B
Guaranteed issue rights

Enrollment Periods:

Annual Election Period: October 15 to December 7
Medicare Disenrollment Period: January 1 to February 14
Initial Coverage Enrollment Period (ICEP):  Within 3 months of your 65th birthday, and 3 months after your birthday month
General Enenrollment Period: January 1 - March 31    If you did not sign up for Part A and/or Part B (for which you must pay premiums) when you were first eligible, you can sign up. Your coverage will begin July 1. You may have to pay a higher Part A and/or Part B premium for late enrollment.    

Special Election Period: when circumstances apply such as moving into a new area, change in Medicaid eligibility, full and partial dual eligibility.  Within 60 days of losing your group health coverage.
Open Enrollment Period for Institutionalized Individuals (OEPI): a continuous period for individuals who move into, reside in, or move out of an institution.  OEPI ends two months after the month the individual moves out of an institution.

 

Source: 1 Anthem, Senior Marketing Done Right 8-2011
            2 Choosing A Medigap Policy: A Guide to Health Insurance for People with Medicare
Disclaimer:  The information provided on this internet page is for educational purposes. Consult Medicare and You Handbook for additional information.

Resources:

Medicare 1-800-MEDICARE or TTY users call 1-877-487-2048

Websites:

www.medicare.gov
www.blueshieldca.com
www.anthem.com/ca
www.healthnet.com/medicare 
www.aetnaseniorplans.com  and www.coventry-medicare.com
www.aarpmedicareplans.com 

www.silverscripts.com

www.silverandfit.com

www.silversneakers.com

 

 

 

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