Health Insurance Now !

Posts Tagged ‘medicare part b’

Most people have heard of Medicare, but the specific details of this federally funded program are not as familiar as the name. If you are a health insurance agent or an individual approaching the age of 65, you will want to learn more about Medicare benefits.

Medicare provides medical insurance for older adults and those who qualify with a disability. It is composed of two main parts, Part A, which is a hospital insurance plan; and Part B, which is supplementary medical insurance.

Every American that is 65 or older and entitled to Social Security is eligible for Medicare benefits. Benefits become available to the individual on the first day of the month of the individual’s 65th birthday. Individuals under age 65 who qualified for Social Security Disability for at least two years are also eligible for Medicare benefits. If you are unsure of your eligibility, you can contact the Office of Medicare Services.

Part A provides benefits for inpatient hospital services for up to 90 days in each benefit period. Benefits also include payment for prescription drugs only while in the hospital. It should be noted that there is no coverage provided for the first three pints of blood that the individual may have received while in the hospital.

Part A also includes limited skilled nursing care. Skilled nursing is provided for up to one hundred days, in which the first twenty days are paid for after the deductible is met. Days twenty one through one hundred fall under the coinsurance amount of coverage. Some home health services are provided, if deemed medically necessary. Hospice care and psychiatric inpatient treatment are also covered under Part A. Psychiatric hospital care covers up to one hundred ninety days during the individual’s lifetime.

Part B provides supplementary benefits and is a voluntary medical insurance plan. Part B pays benefits for physician and surgeon fees, medical services and supplies, outpatient hospital services, x-rays, lab tests, and other services such as ambulance service and durable medical equipment. For Part B benefits, individuals pay a monthly premium and have an annual deductible. Under this plan, there are certain exclusions such as: eye and hearing examinations, routine physical exams, foot care, immunizations and private nurses.

Part C are Medicare Advantage plans, which allow participants to opt out of the traditional Part A and B and enroll in a coordinated care HMO, PPO, PSO or a private fee for service plan. Health Maintenance Organizations (HMOs) require services to be provided by its own providers, except in an emergency. Preferred Provider Organizations (PPOs) allow beneficiaries to receive services from providers outside the plan, but with higher cost sharing. Provider Sponsored Organizations (PSOs) are similar to PPOs, but they are operated by a group of physicians and hospitals. Private fee for service plans are like PSOs but they may pay providers more than Medicare recognizes and can charge beneficiaries additional premiums and cost sharing payments.

If you are an individual approaching qualification for Medicare it is best to contact a health insurance agent that specializes in Medicare products. You may also want to contact your Medicare office or contact your local Area Agency on Aging.

Want to find out more about Medicare Advantage Plans, then visit Bennett David’s site on how to choose the best Medicare Plan for your needs.

Since 1965 when then President Lyndon Johnson signed it into law, Medicare has been a part of Social Security legislation. The original set of revisions had two parts, Part A or Hospital Insurance and Part B or Medical Insurance. As of 2008, 45 million Americans were enrolled in the single-payer program. By 2030, the baby boom generation is expected to be fully enrolled, bringing the number of enrollees to a projected 78 million individuals. The program size makes it the largest social service program of its type in the world.

The program is partially funded by employer and employee payroll taxes collected by the Federal Insurance Contributions Act (FICA) and the Self-Employment Contributions Act of 1954. The cost of a payroll-based tax is 2.9 percent, of which half is paid by the employee and half by the worker. When the beneficiary is self-employed, the entire amount must be paid into the program.

Eligibility for the original Part A and B of this program is offered to any U. S. Citizen age 65 or older. The premium costs are waived if the worker has paid into FICA for ten years. Part A coverage is the portion available for hospital expenses. The inpatient hospital costs such as physician and nursing care, medicines and medical procedures and tests are all covered. There is a deductible cost that must be paid out-of-pocket. Part A also covers convalescent care in a skilled nursing facility. Again, deductibles and co-payments apply.

Part B coverage is for the purpose of medical costs. It is optional, but unless the individual or spouse is working, there is a penalty for not enrolling in the program. Part B covers many of the outpatient costs. Some of the benefits under Part B include physician and nursing services, administration of medications by a physician, medical equipment, prosthetic equipment and other related equipment and supplies.

Private insurance plans can be used to pay benefits under Part A and Part B, Part C became operable under the 2003 Prescription Drug, Improvement and Modernization Act. This part of the program adds the ability to cover prescription medications. The cost of Part C premiums are in addition to those of the original program parts.

The latest addition to the program is Part D. It is intended to pay for stand-alone medication plans. Sometimes it is in conjunction with Part C plans. This part of the programs requires that those receiving benefits contribute out-of-pocket expenses as well as premiums.

Most Part A beneficiaries don’t have to pay premiums. The premiums for Part B are $96.40 monthly. These premium costs are automatically deducted from Social Security retirement benefits payments. The type of program and level of coverage determines the premium costs for Parts C and D. With some of the Part C plans, part or all of the Part B premium costs are returned to the enrollees.

The entire Medicare program is administered by the federal government. Complaints about fraud and abuse are common, but they are usually directed at hospitals, physicians and surgeons who bill the program for services. The changes in U. S. Law will affect the provision of services for health care in the future, but it remains to be seen what the extent of the changes will be.

Looking to find the best deal on medicare part b, then visit www.insurehealthonline.com to find the best advice on medicare part d plans for you.