There are 700,000
Americans aged 100 and over.
was signed into law by President Lyndon Baines Johnson in 1965 as part of
the Great Society Programs and was first championed by President John
Fitzgerald Kennedy during his campaign. Medicare
Advantage and prescription drug coverage were added under
President George Walker Bush. President Harry Truman was the first
to enroll in Medicare. There are now 45 million Medicare enrollees.
There are 4 Medicare
Part A/Original Medicare is a fee-for-service hospital plan
which means you pay the Medicare-approved fee each time you receive
in-patient treatment in a hospital or a skilled nursing home.
Medicare Part A/Original
Medicare is free if you or a spouse has 40 or more quarters of
Medicare-covered employment. You will be automatically enrolled at age 65
if you are receiving Social Security or Railroad Retirement Income.
If you or a spouse has
30-39 quarters of Medicare-covered employment, the monthly Part A premium
for 2010 is $254.00 a month.
If you/spouse have fewer
than 30 quarters of Medicare-covered employment, the monthly Part A
premium for 2010 is $461.00.
Part B/Original Medicare is a fee-for-service plan which pays
80% of the Medicare-approved fee each time you receive outpatient
treatment or treatment from a doctor. You pay 20%.
There is a monthly premium based on income for
Medicare Part B/Original Medicare. Enrollment is optional.
Part B/MediGap is supplemental private insurance to Original
Medicare and includes 12 different policies alphabetized A, B, C, D, E, F,
G, H, I, J, K, L. No matter which insurance company offers these
alphabetized policies - for example Coverage J - the coverage will be the
same although the premiums, deductibles, co-pays, etc. may differ.
Part B/MediGap plans are subrogated private insurance plans
which means that the Medicare Part B/MediGap insurance company will pay
after Original Medicare pays.
Please note that you must
be enrolled in Medicare Part B in order to enroll in Medicare Part
B/MediGap or Medicare Part C/Medicare Advantage.
Part C - Medicare Advantage Plans including Medical Savings
Advantage Plans are offered by private insurance companies
which have been approved by Medicare. Medicare Advantage Plans
incorporate Part A and B into Part C. (See below for a fuller
explanation of Medicare Advantage.)
Part D - Medicare Prescription Drug Plans
The bill for medical
procedures is the same no matter which Medicare plan you choose. The
difference is your share of the cost.
Election Period for Medicare Advantage
in 2010 is between November 15,
2010, and December 31, 2010, for coverage effective January 1,
2011. During the Annual Election Period you can make any kind of
change. (You have until January 31, 2011, to enroll in a Medicare
Advantage plan or a Medicare Prescription Drug plan, but coverage won't
begin on January 1, 2011.)
in 2011, after the 2010 Annual Election Period, you may only
change from Medicare Advantage to Original Medicare, and then only from
January 1, 2011, to February 14, 2011. You can purchase a Medicare
Part D Prescription Drug plan from January 1, 2011, to February 14, 2011
when making the change.
Election Period for Medicare Advantage
in 2011 is between October 15, 2011, and
December 7, 2011, for coverage beginning January 1, 2012.
Enrollment Period is between January 1 and March 31 for
those who did not enroll in Part B when they first became eligible.
Election Period accommodates exceptions to the Annual Election
Period and the Open Enrollment Period; for example, if you turn 65 outside
of the Annual Election Period and the Open Enrollment Period or move
outside your plan's service area. There are other exceptions.
- April 1 to December 31. No changes can be made except those
available through the Special Election Period.
Part C/Medicare Advantage is subrogated private insurance to
Original Medicare and includes the following options:
Fee-For-Service Plan (PFFS)
Savings Account Plan (MSA)
Part C/Medicare Advantage plans are subrogated private
insurance plans which means the Medicare Part C/Medicare
Advantage insurance company pays your claim and subrogates/rebills
Original Medicare for coverage Original Medicare normally covers - which
is why you still pay the premium for Original Medicare Part B (Part A
is free if you or a spouse has 40 or more quarters of Medicare-covered
employment) when you are enrolled in Medicare Advantage Part C. The
Medicare Part C/Medicare Advantage insurer then absorbs the cost of your
claim for services above when Original Medicare covers. Medicare
Advantage passes the total cost of hospice care to Original Medicare.
Part C/Medicare Advantage plans must provide at least the same
coverage that Original Medicare provides, but Medicare Part C/Medicare
Advantage is allowed to provide better coverage.
All, some, or none of Medicare Plan C/Medicare Advantage plans may
be offered in your residing area. Your residing area is the county
in which you live.
Unlike Original Medicare,
Medicare Advantage/Part C does not have to be accepted by providers -
physicians and hospitals - who are otherwise in the Medicare
program. Therefore, it is important to
check with each of your providers before signing up to insure that they
will accept the Medicare Advantage Part C plan you are considering.
If your provider does not
presently accept the Medicare Advantage Plan in which you would like to
enroll, contact the insurance company and ask them to contact your
provider. Since Medicare Advantage is fairly new, your doctor may
not know about it. You can also ask your doctor's office to contact
the insurance plan you are considering to inquire about participation.
you are considering a drug plan in Part C or in Part D, make sure
your prescription drugs are covered by the plan before enrolling.
Since Medicare Part
C/Medicare Advantage is subrogated to Original Medicare, you must be
enrolled in Original Medicare and pay the Part B premium to enroll in
Medicare Part C/Medicare Advantage.
Part C Medical Savings Accounts may be opened at a financial
institution of your choosing or you can use the financial institution the
insurer recommends. In the example below, Advantra will deposit
$1,200 into your medical savings account in January 2009, from which you
can pay medical bills by writing a check or paying by debit card.
You can visit any doctor you wish and also pay for dental services.
There is a $2,700 deductible after which all Original Medicare coverages
are paid in full by the insurer. Whatever portion of the $1,250
deposit you use for covered Original Medicare services (although you can
pay for dental services, dental care is not covered by Original Medicare
and, therefore, does not count toward the deductible) will be applied
toward the deductible. If you do not use all of the $1,250 in 2009, the
balance will roll over into January 2010. The Medical Savings
Account/MSA you choose to open may pay interest which will be tax free as
is the amount deposited to you by the insurer by way of the Social
Medicare Advantage/Part C
coverages are by county. Each county in the United States has
different Medicare Advantage/Part C plans. Please visit Medicare.gov for coverages in your
county if you county has not yet been added to this website.
Please remember to make sure your provider accepts your
chosen Medicare Advantage/Part C policy before enrolling.
Since Medicare Advantage/Part C is a relatively new program, not all
Medicare Advantage/Part C insurers have providers in all counties.
However, If your Medicare Advantage/Part C provider offers Medicare
Advantage/Part C policies in a county different from your county, even
though it is a different policy than the one offered in the county in
which you are enrolled, you are covered. For example, you are
enrolled in Insurance Company A's Best Insurance Policy No. 1 offered in
your residing county, but your doctor is in another county which offers
Insurance Company A's Best Insurance Policy No. 7, but not No. 1 You
You may choose a Medicare
Advantage Plan/Part C without drug coverage and couple it with an Original
Medicare/Part D Medicare Prescription Drug Plan to obtain drug
coverage. You may not choose a Medicare Advantage/Part
C plan with drug coverage and couple it with an Original Medical/Part D
plan. Medicare does not allow you to
have two prescription drug plans.
from Medicare: "If you are in a Medicare
Advantage Plan that includes prescription drug coverage and you join a
Medicare Prescription Drug Plan, you will be disenrolled from your
Medicare Advantage Plan and returned to Original Medicare."
Pediatrician and Harvard
School of Public Health professor Dr. Donald Berwick was recessed
appointed by President Barack Obama to head Medicare.
Recess appointments bypass Congress by being appointed when Congress is
not in session. Recess appointments expire at the end of the current
session of Congress which in this case is December 17. The current
Congress is the 111th, Second Session. The First Session of the
112th Congress will begin in January of 2011.
Dr. Berwick has
fully-paid healthcare coverage for himself and his spouse, "from
retirement until death" provided by the Institute for Health Care
Improvement, a non-profit company he created.
Two of Dr. Berwick's
books are available in the left column.