TRIO Medicare News
Medicare UPDATE Nov 2011....
The Medicare Enrollment Period began earlier this year- October 15, 2011
The Medicare Enrollment Period began earlier this year- on October 15, 2011 in order to give Medicare recipients seven weeks to make their choices. Those options include selecting traditional Medicare or a Medicare Advantage plan that is operated by a private company and usually has benefits similar to an HMO or PPO.
Recipients also can opt for a Medicare supplement if they stick with traditional Medicare as well as a prescription drug plan.
There are two ways one can get Medicare health benefits: through Original Medicare or through a Medicare Advantage plan.
Most people with Medicare can choose one or the other, and you can change your selection each year during Fall Open Enrollment (October 15 – December 7).
Original Medicare is the traditional fee-for-service program in which you get your Part A (inpatient) and PartB (outpatient) benefits directly from the federal government. Most people get their Medicare this way. With Original Medicare, you can go to any doctor or hospital in the country that accepts Medicare. You use your red, white and blue Original Medicare card when you get health services.
Original Medicare doesn’t pay for everything, so you’ll have some out-of-pocket costs. In addition to a monthly premium, there are deductibles you must meet before Medicare starts paying for your care. After reaching the deductible, you pay an 80% coinsurance for most Medicare-covered outpatient services. You may be able to buy a supplemental Medigap policy to help pay some of these costs.
There are also some things that Original Medicare never covers, such as routine dental and vision care.
The other way to get your Medicare health benefits is through a Medicare Advantage plan. Medicare Advantage plans are sold by private insurance companies. You still have Medicare if you have a Medicare Advantage plan, but instead of getting Part A and B from the government, you get them from a private company. You use your Medicare Advantage plan insurance card when you receive services.
Medicare Advantage plans must cover the same things that Original Medicare covers, but they can have different restrictions and costs. They’re usually HMOs or PPOs that use networks of doctors and may require referrals or prior approval before you get certain types of care. In a Medicare Advantage plan, there are sometimes deductibles and usually co-pays for services you receive. You also may have to pay a higher monthly premium. Some plans, however, cover extra services that Original Medicare doesn’t cover. Medicare Advantage plans also must have caps on out of pocket costs in order to protect you. These caps can be high but will help protect you if you need a lot of medical care.
If you want Medicare prescription drug coverage (called Part D), you should also consider this during Fall Open Enrollment. How you get your medication coverage depends on whether you have Original Medicare or a Medicare Advantage plan. If you choose Original Medicare and want Part D, you must buy a stand-alone prescription drug plan (PDP) that only covers drugs. If you choose Medicare Advantage and want Part D drug coverage, you usually receive it (usually but necessarily always) as part of your Medicare Advantage plan.
I hope this helps with some of the options. It's very important that if you wish to make changes, that you make those changes during the proper time such as the fall enrollment period outlined above.
- Mike Sosna
TRIO Public Policy Committee Chairman
For specific Medicare and local insurance options:
Reach out to your transplant social worker. Every program is more familiar with this subject as it relates for your particular situation and your state's support and insurance options, so let them help you.
Make your comments on the story above? click on: TRIO Bulletin Board Log in and post your questions, ideas and topics. Communicate with other transplant recipients, donors and families. Check out our new topics and add your own suggestions. Help build this community with your own postings to help others. Add your own questions and thoughts.