To give you some general information, we address some of the most commonly asked questions people have about Medicare. If you have a question you don’t see answered here, please visit Medicare at www.medicare.gov.
- What is Medicare?
- What does Medicare Part A cover?
- What does Medicare Part B cover?
- What is Medicare Prescription Drug Coverage?
- Where can I find out if Medicare covers a service or supply I need?
- What is the difference between Medicare and Medicaid?
- What will Medicare cost me?
- What are my options for other coverage?
Medicare is the federal health insurance program for:
- People 65 years of age and older.
- Some people under age 65 who have disabilities.
- People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
Medicare has several parts, including:
Medicare Part A helps pay for:
- Care in hospitals as an inpatient
- Critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas)
- Skilled nursing facilities
- Hospice care
- Some home health care
For more information about Medicare Part A coverage, visit the Your Medicare Coverage database.
Medicare Part B (Medical Insurance) helps pay for:
- Doctors’ services
- Outpatient hospital care
- Certain medically necessary services, such as physical and occupational therapists and some home health care
For more information about Medicare Part B coverage, visit the Your Medicare Coverage database.
Medicare Prescription Drug Coverage (also known as Medicare Part D) helps cover your prescription drug costs. Medicare created the new prescription drug plan to help people with Medicare afford prescription drug coverage. It went into effect January 1, 2006. Medicare beneficiaries can only enroll in an organization that has a contract with Medicare, such as Elderplan. Except for Elderplan Medicare Part B Reduction W/O Rx (HMO), this plan does not offer Drug Coverage.
Plus, with Elderplan, there’s no need to enroll in a separate prescription drug plan. That’s because Elderplan is a Medicare Advantage Part D (MA-PD) plan, which includes the Medicare Prescription Drug coverage.
Answers about what Medicare covers can be found in the “Find Out What Medicare Covers” section on www.medicare.gov. This section of the website provides information about your health care benefits in the Original Medicare plan (sometimes referred to as “fee-for-service”). By searching this database, you will find:
- Some of the services and supplies the Original Medicare plan covers;
- The conditions that must be met for some services or supplies to be covered;
- How often services or supplies are covered (limits);
- How much you pay;
- Who you can contact if you have additional questions;
- Some of the services and supplies the Original Medicare plan does not currently cover.
Please note that some services and supplies are statutorily excluded from Medicare coverage. Congress would need to change Medicare in order for current excluded services and supplies to be covered.
Medicare is an insurance program. Medical bills are paid from trust funds that Medicare beneficiaries have paid into. Medicare primarily serves people over age 65, whatever their income. It also serves younger disabled people and individuals with End-Stage Renal Disease. Patients pay part of costs through deductibles for hospital and other costs. Monthly premiums are required for non-hospital coverage. Medicare is a federal program. It is basically the same everywhere in the United States and is run by the Centers for Medicare & Medicaid Services (CMS), an agency of the federal government.
For more information regarding Medicare and its components, please visit www.medicare.gov.
Medicaid is an assistance program. Medical bills are paid from federal, state and local tax funds. Medicaid serves low-income people of every age. Patients usually pay no part of costs for covered medical expenses. A small co-payment is sometimes required. Medicaid is a federal–state program. It varies from state to state. It is run by state and local governments within federal guidelines.
Elderplan Medicare for Medicaid Beneficiaries (HMO) is our plan that was designed specifically for people with Medicare and Medicaid who are designated as Qualified Medicare Beneficiaries or Qualified Medicare Beneficiaries Plus. Elderplan also offers Elderplan Medicare Plus Medicaid Advantage (HMO) for Medicare beneficiaries who have both Medicare and Medicaid, and for Medicare/Medicaid Beneficiaries who are Nursing Home Certifiable Elderplan offers Elderplan Plus Managed Long-Term Care (HMO).
2010 Premium Amounts
Depending on your eligibility, there are three possible premiums for Medicare Part A Hospital Insurance.
- Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.
- The Part A premium is $254.00 per month for people having 30–39 quarters of Medicare-covered employment.
- The Part A premium is $461.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.
Part B: (Medical Insurance) Premium
- $110.50 per month – however most Part B enrollees will continue to pay $96.40 which was the 2009 rate.*
Medicare Deductible and Co-insurance Amounts for 2010:
Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2010 = $1,100) during the first 60 days and co-insurance amounts for hospital stays that last beyond 60 days and no more than 150 days.
For each benefit period you pay:
- A total of $1,100 for a hospital stay of 1–60 days.
- $275 per day for days 61–90 of a hospital stay.
- $550 per day for days 91–150 of a hospital stay (Lifetime Reserve Days).
- All costs for each day beyond 150 days.
Skilled Nursing Facility Co-insurance
- $137.50 per day for days 21–100 each benefit period.
Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)
- $155.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $135.00 deductible.)
*Note: Most people will pay the standard monthly Part B premium of $96.40 in 2009. Some people will pay a higher premium based on their modified adjusted gross income.
What are my options for other coverage?
If you have both Medicare Part A and Part B, you can sign up for Medigap insurance or a Medicare Advantage plan from a private provider. These options may offer coverage beyond what Medicare covers. You may also sign up with a Special Needs Plan like Elderplan Classic I Medicare Extra Needs (HMO), Elderplan Medicare for Medicaid Beneficiaries (HMO), Elderplan Medicare for Nursing Home Residents (HMO), Elderplan Medicare Plus Managed Long-Term Care (HMO) or Elderplan Medicare Plus Medicaid Advantage (HMO) to receive more coverage than Original Medicare. You can also join one of our standard Medicare Advantage plans, like Elderplan Medicare Part B Premium Reduction (HMO) or Elderplan Medicare Part B Premium Reduction w/o Rx where you receive a $40 reduction in your Part B premium each month. Another choice would be the Elderplan Medicare Extra Help (HMO) plan, which is designed for beneficiaries who have Low Income Subsidy, or you may choose Elderplan Medicare Premium Benefit Plan (HMO/POS), our point of service plan that offers out-of-network benefits (your out-of-pocket costs may be higher if you use out-of-network providers, except for emergency care, urgently needed care when our network is not available or out-of-area dialysis services). While there are several options to consider, one place to begin a search would be with the Medicare Options Compare on the Medicare Website. Or, call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048, 24 hours a day, 7 days a week.