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Georgia Medicare Part B helps cover medically-necessary services like doctors’ services, outpatient care, home health services, and other medical services. Part B also covers some preventive services. Check your Medicare card to find out if you have Part B.

Does Medicare pay for health screenings?

 

 

How Much Does Medicare  Part B Cost?

You pay the Part B premium each month (in 2018 the standard premium is $134). Most people will pay the standard premium amount. However, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay more.

Your modified adjusted gross income is your taxable income plus your tax exempt interest income. Social Security will notify you if you have to pay more than the standard premium. If you have to pay a higher amount for your Part B premium and you disagree (even if you get Railroad Retirement Board benefits), call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.

If you don’t sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty.

 

Common Medicare Questions

Which plan is right for me? Medicare Advantage or original Medicare and a supplement plan? How much should I expect to pay for a GOOD Medigap plan?

Is Anthem/Blue Cross a good choice? Does it include Silver Sneakers?

Medicare. You have questions. We have answers.

Call or email.

 

Medicare basic benefits and coverage is divided into four parts. Medicare Part A and Medicare Part B are government insurance plans while Part C and Part D are private insurance plans. Medicare 101

With original Medicare (part A and part B) you are free to use any doctor that accepts Medicare assignment. With Medicare Part C or Part D, you must find a doctor willing to accept the private insurance companies terms and fee schedule.

When you have original Medicare you and your doctor decide the level of care you need.

Basic Medicare or Medicare Advantage?

With Medicare Part C (Medicare Advantage) the insurance company makes those decisions for you.

Medicare Part D

Medicare Part D (prescription drug coverage) is also handled by private insurance companies. Some may feel Part D is a waste of money. Prescription drugs are available at a discount through mail order services such as Blue Sky that are much cheaper than meds covered by your Part D.

But if you fail to sign up for Part D when first eligible you will be required to pay a late enrollment penalty of 1% per month for every month you could have enrolled in Part D but failed to do so.

Medicare Supplement Insurance – Medigap

Most seniors age 65 and older opt for original Medicare and a supplement plan, also known as Medigap. Medigap plans are assigned letters by CMS which denotes the benefits of each plan. Medigap plans offered in Georgia are plans A, B, C, D, F, G, K, L, M, N and Hi F.

Popular Medigap carriers include Blue Cross, Mutual of Omaha, Gerber, Humana and New Era.

Georgia Medicare Plans has affordable rates for Medigap plans from all major carriers.  You can run rates online using our quote engine or ask for a personalized quote based on your needs.

Most Medicare supplement carriers do not illustrate their rates online. The only way to view the most options is to request a personalized Medigap quote.

This is a list of commonly used terms by those who service Medicare beneficiaries. If you have original Medicare and Medigap, or if you have an Advantage plan, you will encounter these words from time to time.

A

Any willing provider – Any doctor, hospital or medical practitioner that accepts Medicare assignment of benefits and agrees to the terms and conditions set forth by CMS.

Approved amount – Medicare set’s prices it considers adequate payment for medical services. This is the approved amount.

Assignment – Medical providers who accept the Medicare approved amount for services as payment in full. Seniors will save money by choosing doctors that accept assignment.

B

Beneficiary – One who is covered by original Medicare

Benefit period – Your benefit period begins the day you are admitted to a hospital or skilled nursing facility (SNF) and ends when you have not received any care for that illness or injury for 60 consecutive days. If you are admitted to a hospital or SNF after your benefit period ends you must satisfy a new deductible. There is no limit to the number of benefit periods you may have during a calendar year.

C

Carrier – A private insurance company that is approved to write coverage in your state. Carriers providing Medicare Advantage plans (Part C) and Prescription Drug Plans (Part D) must also be approved by CMS. Medicare supplement carriers are approved by your state but are not approved by CMS.

CMS – Center for Medicare Services.

Coinsurance – An amount you may be required to pay after you have satisfied your deductible. With original Medicare the amount is typically 20% of the approved amount billed after the deductible.

Copay, copayment, co-pay, co-payment  – With some Advantage plans and Drug plans you are required to pay a fixed dollar amount every time you receive a service or purchase a prescription drug. Copay’s are also used for some outpatient hospital services covered by original Medicare.

Creditable coverage – Prior health coverage that affords you rights to supplement plans without restriction for pre-existing medical conditions. Examples of creditable coverage include an employer group health plan, COBRA, individual major medical coverage and Medicaid. Prior creditable coverage, without a break in coverage, allows you to bypass any waiting periods that might be imposed by a Medigap carrier.

Custodial care – Assistance provided by non-skilled personnel such as in an assisted living facility. Custodial care is not covered by original Medicare.

D

Deductible – An amount you must pay before original Medicare, your supplement plan, drug coverage or other insurance will pay. Original Medicare has deductibles that must be met before your Part A (hospital coverage) or Part B (doctor coverage) will pay. The deductible changes every year.

Drug list – Also called a drug formulary. This is a list of approved medications that are covered by your plan.

DME, Durable Medical Equipment – Medicare approved equipment for use outside the hospital. These can include wheelchairs, walkers, braces, hospital beds just to name a few.

Donut hole, doughnut hole – The coverage gap which you must pay under your Part D, prescription drug plan.

Dual eligible – One who is eligible for Medicare and public assistance through Medicaid.

E

Election period – The time during which you may enroll in original Medicare or an Advantage plan.

Enrollment period – A time when you may enroll or switch Medicare plans.

End of Life Counseling – A provision in Obamacare that would have paid your doctor extra to initiate end of life counseling and planning. This provision was repealed by HHS in January, 2011. You may still wish to discuss how much, or how little care you receive if you have a terminal illness, but your doctor will not receive a cash incentive to initiate these discussions.

ESRD, End Stage Renal Disease – Permanent kidney failure requiring dialisys or a kidney transplant.

Excess charges – The difference between what original Medicare allows and your doctor’s charge for services. If your doctor accepts assignment, they are limited in how much they can charge over and above the amount allowed by CMS.

G

Grievance – The process by which you may file a formal complaint with CMS about the way your plan or staff person has treated you.

Guaranteed issue rights, GI – Your rights under which a private insurance plan may not refuse to offer you coverage. In these situations, a carrier cannot refuse to offer you a policy or set restrictions on your coverage. If you apply during your guaranteed issue period, the carrier cannot charge you extra for pre-existing medical conditions or place exlusions on those conditions.

Guaranteed renewable – Medigap plans are guaranteed renewable (unless stated otherwise in the policy) and cannot be cancelled unless you have made false statements about your health on the application or have failed to pay the premium on a timely basis.

S

SWAN, S.W.A.N. – Sleep well at night. When you have the right plan to protect your assets and you can rest assured knowing your medical bills will be paid, you can sleep well at night.

Medicare Advantage Plans in GA are privately run senior health insurance plans that replace traditional Medicare coverage. Most are either an HMO or PPO and require you to use a doctor or other medical provider that has agreed to the terms and pricing structure for the network.

Medicare Advantage Plans = Fewer Choices

Medicare Advantage Plans have more restrictions and fewer provider choices than original Medicare and a Medigap plan.

• If you change to an Advantage Plan you may find that the doctor you have been seeing for years does not participate in your new plan and will only see you on a cash basis.
• Advantage Plans typically have low premiums, in some cases $0. The trade off is higher out of pocket when you need it most.
• Traditional Medicare and a comprehensive Medigap plan F supplement typically means you have $0 out of pocket for hospital and doctor bills when approved by Medicare.
• When you have a Medicare Advantage Plan, private insurance carriers, not Medicare, decide which claims will be paid and which will be denied.
• A large hospital bill that is approved by your Medicare Advantage carrier may leave you owing $3,000 or more once the dust settles.
• When you want to see a specialist you must first have a referral by your PCP (primary care physician) and that referral must be approved by your Advantage carrier.
• The rules for Medicare Advantage plans change every year

Medicare Advantage Pluses

To be fair, there are positive things about Medicare Advantage Plans.

• Advantage plans may include “extra” benefits such as limited vision or dental coverage
• Advantage plans require copay’s for doctor visits. Something you won’t find with most Medigap plans.
• Many Advantage plans include prescription drug benefits. Sometimes the “package” covers the medications you need, sometimes not.
• If you switch from original Medicare to an Advantage plan and you are not satisfied, you may disenroll during the first 12 months of your Special Enrollment Period (SEP) and return to original Medicare.

Types of Medicare Advantage Plans in GA

Most  Advantage plans will fall in to one of the following categories.

• PPO
• HMO
• PFFS
• SNP

Why Seniors Leave Advantage Plans

We found this article titled, “As Seniors Get Sicker, They’re More Likely to Drop Medicare Advantage Plans“. Very interesting reading. However there is one issue NPR failed to address.

While it is true you can drop an Advantage plan during open enrollment and return to original Medicare, there is no guarantee you can qualify for a supplement plan.

 

Additional Reading

Differences in Original Medicare and Advantage Plans

Medicare vs Medicare Advantage – How to Choose

Choosing Between Traditional Medicare and an Advantage Plan

 

 

 

Bob Vineyard, President of Georgia Medicare Plans, has decided to specialize in GA Medigap plans. We believe the flexibility and overall VALUE of original Medicare and a supplement plan are superior to the Medicare Advantage plans currently on the market. We invite you to compare GA Medigap quotes using our instant online quote engine or ask for a free, no obligation consult.