Medicare

Medicare Advantage

There are 700,000 Americans aged 100 and over.

Medicare 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 "Parts:"

• Part A

• Part B

• Part C

• Part D

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.

Medicare 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.

Medicare 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.

Medicare 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.

Medicare Part C - Medicare Advantage Plans including Medical Savings Accounts. 

Medicare 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.)

Medicare 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.

Annual 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.)

Beginning 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.

Annual Election Period for Medicare Advantage in 2011 is between October 15, 2011, and December 7, 2011, for coverage beginning January 1, 2012.

General Enrollment Period is between January 1 and March 31 for those who did not enroll in Part B when they first became eligible.

Special 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.

Lockin - April 1 to December 31.  No changes can be made except those available through the Special Election Period.

Medicare Part C/Medicare Advantage is subrogated private insurance to Original Medicare and includes the following options:

• Health Maintenance Organization (HMO)

• Preferred Provider Organization (PPO)

• Private Fee-For-Service Plan (PFFS)

• Medicare Special Needs Plan

• Medicare Medical Savings Account Plan (MSA)

Medicare 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.

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.

If 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.

Medicare 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 Security Administration.

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 are covered.

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.

Warning 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.