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Centers for Medicare and Medicaid Services 2011 Guide to Medicare

2011 Medicare & You Guide

HOW MEDICARE WORKS

Medicare is the federal health insurance program for people over age 65 and those with certain disabilities or end-stage Renal Disease (Permanent Kidney Failure).

There are 4 parts to Medicare:

1. PART A - Hospital Insurance
2. PART B - Optional Medical Insurance
3. PART C - Optional Medicare Advantage Insurance
4. PART D - Optional Prescription Drug Insurance

MEDICARE PART A: Helps pay for care in hospitals, some skilled nursing facilities, hospice, and some health care. For most people, Part A is premium-free because they paid Medicare taxes.

Hospitalized	Medicare Covers	Individual Pays
1-60 days	Most confinement costs after the required Medicare Deductible	$1,132 deductible
61-90 days	All eligible expenses, after the patient paya a per-day co-payment	$283 per day Co-Payment
91-150 days	All eligible expenses except per-day co-payment. 60 Lifetime Reserve Days may not be reused.	$566 per day Co-Payment
151 days or more	Nothing	100%
Skilled Nursing Confinement Must be receiving skilled nursing care in a Medicare approved skilled nursing facility that begins within 30 days after a hospitalization of at least 3 days.	All eligible expenses for the first 20 days; then all eligible expenses for days 21-100, after patient pays a per-day co-payment.	$141.50 per day Co-Payment for days 21-100. All costs after 150 days.

OPTIONAL MEDICARE PART B: Optional coverage to help pay for doctors, outpatient hospital care, and some other medical services not covered by Part A. The chart below shows the Part B monthly premium amounts based on income. These amounts change each year. There may be a late-enrollment penalty.

If Yearly Income is...		Individual Pays
Single Individual Return	Married Joint Return	A late fee is possible
$85,000 or less	$170,000 or less	$115.40*
$85,000 - $107,000	$170,000 - $214,000	$161.50
$107,000 - $160,000	$214,000 - $320,000	$230.70
$160,000 - $214,000	$320,000 - $428,000	$299.90
Above $214,000	Above $428,000	$369.10
*Most people covered in 2011 will continue to pay their 2009 Part B Premium of $96.40 in 2011

Medicare General Enrollment Period is from January 1 through March 31 of each year at a Social Security Administration office. Part B coverage will start on July 1 of that year.

Special Part B Enrollment Periods - while covered by employer or union group health plan or within 63 days of the date when the employer or union group health plan coverage ends, or when employment ends.

Expense	Medicare Covers	Individuals Pay
Medical Expenses Physician's services for inpatient and outpatient medical/surgical services; physical/speed therapy, diagnostic tests	80% of approved amount	$162 Deductible plus 20% of approved amount
Clinical Laboratory Services Blood tests, urinalysis	Generally 100% of approved amount	Nothing for Services
Home Health Care Part-time or intermittent skilled care, home health aide services, durable medical supplies and other services	100% of approved amount; 80% of approved amount for durable medical equipment	Nothing for services 20% of approved amount for durable medical equipment
Hospital Outpatient Hospital services for the diagnosis or treatment of an illness or injury	Medicare payment to hospital, baed on outpatient procedure payment rates	Coinsurance based on outpatient payment rates
Blood	After first 3 pints of blood, 80% of approved amount	First 3 pints plus 20% of approved amount for additional pints

OPTIONAL MEDICARE PART C: An alternative to traditional Medicare, Part C is another way to get Medicare benefits. It combines Part A, Part B, and, sometimes, Part D (prescription drug) coverage. Medicare Advantage Plans are managed by private insurance companies approved by Medicare. These plans must cover medically-necessary services. However, plans can charge different copayments, coinsurance, or deductibles for these services.

OPTIONAL MEDICARE PART D - Prescription Drug Plan: This optional coverage may help lower an individual's prescription drug costs and help protect against higher costs in the future.

FREQUENTLY ASKED QUESTIONS

What is a Medicare Supplement policy and how does it work?
A Medicare Supplement policy is sold by private insurance companies to fill the "gaps" in Original Medicare Plan. In all but three states (Minnesota, Massachusetts, and Wisconsin), there are 12 standard Medicare Supplement plans called "A" through "L". Each plan has a different set of benefits.

Why should someone buy Medicare Supplement Insurance?
There are "gaps" or out-of-pocket costs not covered by Medicare. A Medicare Supplement Insurance policy may fill these gaps. Those with a Medicare Supplement policy if already in a Medicare managed care plan, Private Fee-for-Service plan, Medicare Medical Savings Account plan, or a Religious Fraternal Benefit plan.

When is the best time to buy a Medicare Supplement Insurance policy?
During the open enrollment period.

How is the Medicare Supplement open enrollment period calculated?
The Medicare card shows the dates Part B coverage started. The original open enrollment ends 6 months after Part B coverage starts.

What other situations create a Medicare Supplement open enrollment period?
-Medicare managed care or Private Fee-for-Service plan leaves the program or area
-Insured leaves the health plan's service area
-Medicare health plan fails to meet its contractual obligations
-Employer group health plan coverage ends
-Leave a Medicare Supplement policy to join a Medicare managed care plan, or Private Fee-for-Service plan, or Medicare Select for the first time, and then return to a Medicare Supplement
-Joined a Medicare Health plan first eligible for Medicare at age 65 and within one year of joining decided to leave the Medicare health plan

Can I pay for my own services that are not covered by Medicare? Yes.

Can my Medicare Supplement Insurance company drop me?
Policies sold after 1990 must let you renew unless you do not pay the premiums, you lie, or commit fraud under the policy. You may lose a guaranteed renewable policy if the insurance company goes bankrupt or cancels all policies of this type in your state.

Do I have to have my Medicare Supplement policy for a certain length of time before I can switch to a different Medicare Supplement policy? No.