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.
Let's
review:
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.
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.