Category : Insurance
Medicare can be difficult to navigate for the average person. Below are some common questions and answers regarding Medicare. As always, if you need further information, you can call Tawny McWilliams, Resident Services Assistant at Royale Oaks. Her number is 402-557-6296
Question #1: Briefly define Medicare A,B,C,D & include an example:
Medicare Part A:
– Original Medicare
-most people are automatically enrolled & do not pay monthly premiums for this coverage. (because they [or a spouse] paid Medicare taxes while working).
-examples of coverage: inpatient hospital stays, skilled nursing home care following a hospital stay, hospice care, and some home health.
-administered by the Federal Government.
Medicare Part B:
-optional coverage that does involve a monthly premium for most people.
-doctor’s services, outpatient hospital care (ie: ER), prosthetic limbs,etc
Medicare Part C:
-Bundles all medicare covered services into this plan (Med A,B, usually D)
-Ran as a HMO type of insurance & administered by private insurance companies.
Medicare Part D:
-Rx drug coverage aspect; available to all medicare recepients.
-Optional coverage; administered by private insurance providers.
-Variances exist between plans in cost, & covered drugs.
Question 2- Differences amongst Part D plans:
-Nebraska has over 35 different Med D (free-standing) plans for consumers to choose from. 5 of which are benchmarked plans.
-Benchmarked plans are those plans that are identified by the state as having met the mean monthly premium. It is a factor in the plan picking process only for those individuals that are covered by both Medicare and Medicaid.
-It is important to look at 3 factors when choosing the best Med D plan for you:
- COVERAGE: all plans must cover the same categories of drugs, but plans may choose what specific drugs are covered in each category.
- COST: Monthly premiums, annual deductibles, copays & coverage during the gap (ie: Donut hole) all vary amongst plans.
- CONVENIENCE: Drug plans must contract with pharmacies; so check to make sure that the pharmacy you want to use accepts the plan you are looking at.
-The best way to compare all of the different plans & tailor them to your needs is on the medicare website: www.medicare.gov
Question 3: Open Enrollment
-Every year, from November 15-December 31, you may join a Med D plan OR change plans effective Jan 1 of the new year.
-If you already have a Med D plan, it is important to re-evaluate plans during this time as many things change (including costs) of plans. What may be the best plan for you today, is not necessarily the best plan for the new year.
– Benchmark limits are recalculated each year; so the plans that are “benchmarked plans” vary from year to year. Again, this is important only in the dual-eligible category (those covered by both Medicare and Medicaid).