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Enrollment Into Original Medicare: Coverage And Eligibility Explained
Many people approaching the age of 65 are asking the question, “What is Original Medicare coverage?” This is a serious question, and these same people are often uncertain whether they are eligible and how to enroll.
Although the Medicare program has evolved since it first started in 1965, Original Medicare is the single payer, Federal health insurance program for U.S. citizens and legal residents age 65 or older. It now also includes coverage for individuals eligible for Social Security Disability benefits, those who have kidney failure, or ALS (Lou Gehrig’s disease). There is one other Federal insurance payer, the Federal Employees Health Benefits program that covers Federal employees.
Original Medicare coverage includes medical insurance that covers visits to doctors, Medicare supplies and equipment, hospital outpatient care, and many other medical services, such as labs, radiology, and physical therapy. This is the Part B side of Medicare. The Part A of Medicare helps pay for inpatient services. Part A would include coverage for inpatient hospital days, skilled nursing facility stays, and Home Health benefits.
Generally speaking, eligibility is not complicated. If you are a U.S. Citizen or naturalized citizen nearing the age of 65, or disable or have End Stage Renal Disease, you are probably eligible. Eligibility questions can be addressed to the Social Security Administration at 1-800-772-1213.
However, if you are already receiving Social Security Benefits prior to your 65th birthday, then you will be enrolled into Medicare Part A and Part B automatically. The way this works is that approximately 3 months before you turn 65, you will receive you initial enrollment packet that will include your Medicare card. If you want to enroll into both A and B, sign your card and keep it in a safe place. If you want to refuse Part B, simply sign the back of the card form that you receive, put an “x” in the box that says you are refusing Part B, and send the card back using the return envelope. After the SSA receives and notes your decision, you will receive a new card listing your enrollment into Part A, only.
If you are approaching age 65 but not yet receiving Social Security Benefits, the procedure is a little different. In this case, you need to initiate the enrollment process yourself by submitting an application with Social Security. You can do this through your local office, or call the number given above for more information. In either case, whether you are already receiving SSA benefits or not, you have a 7 month initial enrollment period to sign up. This includes the 3 months before the month of your birthday, the month of your birthday, and the three months immediately following the month in which you turn 65.
The one stable piece of information to hold onto is that Medicare enrollment is always done through the Social Security Administration. If you are already receiving benefits, your enrollment will be automatic and you won’t need to do anything at all. If you are not receiving SSA benefits by your sixty-fifth birthday, you will need to submit an application through the Social Security Administration. As this is quite an important change in your life, you should not hesitate to seek answers to your questions through the Social Security Administration toll free number, 1-800-772-1213.
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What You Need To Know To Find The Best Health Insurance For You
How to find the best, low cost health insurance plan? I can’t tell you how important it is to do your homework, and in this article I’ll try to help you with some of that homework. You might think health insurance is all the same, but the devil is in the details and understanding the details may save you hundreds of dollars.
Health insurance, just as with any other sort of insurance, is basically risk management. When you pay an insurance company their monthly fee–called an insurance premium–you are paying them to assume the risk of paying for you health care. The policy that you buy determines the benefits they will pay for should you become ill or injured. When you purchase health insurance, you purchase what is called a policy, which is generally a package of benefits, and the policy spells out the terms and conditions under which the company will pay.
When you shop for health insurance, you discover that there are many different kinds and packages. For many people, health insurance means a coverage that pays the bills for doctor visits, outpatient hospital care, and inpatient stays. However, there are other kinds as well, such catastrophic health coverage, maternity coverage, and dismemberment insurance to name just a few examples. When you search for health coverage, you find an assortment of plans each offering its own package of benefits with its own rate of payment. The insurance plan is the “package” of benefits, and the benefits describe exactly what the insurer will pay for. For this reason, it is important that you understand the package so that you know what to expect when you receive health care.
Some of the more common kinds of health insurance plans are the Health Maintenance Organization, or HMO; the Preferred Provider Organization, or PPO; and the Private Fee for Service Plan, or PFFS. HMO plans are generally less expensive, but they required that you use only the doctors, hospitals, and other health care providers who have a contract with the insurance company to provide service. You are usually assigned a primary care doctor and must get a referral to see a specialist. The plan ultimately determines whether or not you can see a specialist and what services and how many of each service you may receive. If you are in relatively good health and have relatively few medical needs, an HMO might work out for you. If you have a more complicated medical history, you would want to thoroughly investigate the insurance company and specific HMO to be sure they have a reliable record of meeting patients coverage needs. Kaiser Permanente would be an example of an HMO, and Kaiser Health Care generally is generally well-known throughout the United States.
The PPO is more flexible than the HMO plan. PPOs may also be a bit more expensive than HMOs, and that is because PPOs are generally thought to give a higher level of coverage. In PPOs, you are not required to have a primary care doctor, and you generally do not need a referral to see a specialist. PPOs have their own network of contracted medical personnel but allow you to go out of the network to see doctors of your own choosing. Now, that costs you more. Before signing up for a PPO, it is important that check with your providers to determine whether they are in the network or will otherwise file claims and accept payment from that particular insurance company. Major insurance companies such as Aetna and Blue Cross Blue shield, Wellmark Blue Cross, and Humana offer PPO plans as well as HMO variants.
A private fee for service plan (PFFS) is yet another kind of managed care. However, this sort of plan does not require you to receive care from a network of providers. In the PFFS plan you can receive care from any doctor, hospital, or other health care provider who accepts the plans payment terms. It is advisable that you always check with your providers first before receiving services to be sure that they will, in fact, submit claims to the insurance company. In a PFFS, instead of offering a package of fixed benefits (as in an HMO and PPO), the company pays a set fee for each service you receive that the provider bills to the insurer.
Just what are the real costs of a health insurance policy? The answer to that question will depend in part on the cost of monthly premiums, the deductibles, and the co-pays and co-insurances that you can expect to pay. There is another factor as well that is often ignored, and that is the reliability of the insurance company. If possible, you want to get the best idea you can of the actual reputation of the company for meeting its coverage obligations. In other words, is the company going to pay on the claims per the policy agreement, or will you have to fight every step of the way for your health care. You can see that a plan with a cheap premium could turn out to cost more than a more expensive plan if less expensive plan refuses to pay the medical claims.
Low cost health insurance is attainable, but real secret is determining the benefits you need the most and then stripping everything else out of the policy. In other words, pay for as few services as possible and then add to that the highest deductible you think you could afford to pay if the need arose. Earlier, I mentioned the reliability factor. Do not buy a policy from a company until you get some idea of its customer service record. know before you go. Should a time of need arise, you want the security of knowing that the company will live up to its agreements.
Free tips to help get cheap ppo health insurance and finding cheap health insurance for the family.