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fafy
11-08-2006, 01:11 AM
Please someone light me: can you simply explain the different options with the medicare part C? And what is the traditionnal medicare fee for service: is it only part A+B or something else?Please heeeeelp!!!

charlesjain
11-08-2006, 03:02 AM
Question What are the Medicare premiums and coinsurance rates for 2007?
http://questions.medicare.gov/rnt/rnw/img/trnsp.gif Answer The following is a listing of the Medicare premium, deductible, and coinsurance rates that will be in effect in 2007:
Medicare Premiums for 2007:
Part A: (Hospital Insurance) Premium

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 $226.00 for people having 30-39 quarters of Medicare-covered employment.
The Part A premium is $410.00 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
$93.50 per month*
Medicare Deductible and Coinsurance Amounts for 2006:
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 (2007 = $992) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.
For each benefit period you pay:

A total of $992 for a hospital stay of 1-60 days.
$248 per day for days 61-90 of a hospital stay.
$496 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
All costs for each day beyond 150 daysSkilled Nursing Facility Coinsurance

$124.00 per day for days 21 through 100 each benefit period.Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)

$131.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $131.00 *Note: If your income is above $80,000 (single) or $160,000 (married couple), then your Medicare Part B premium may be higher than $93.50 per month. deductible.)

charlesjain
11-08-2006, 03:03 AM
Question What are the Medicare premiums and coinsurance rates for 2006?
http://questions.medicare.gov/rnt/rnw/img/trnsp.gif Answer The following is a listing of the Medicare premium, deductible, and coinsurance rates that will be in effect in 2006:
Medicare Premiums for 2006:
Part A: (Hospital Insurance) Premium

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 $216.00 for people having 30-39 quarters of Medicare-covered employment.
The Part A premium is $393.00 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
$88.50 per month.
Medicare Deductible and Coinsurance Amounts for 2006:
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 (2006 = $952) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.
For each benefit period you pay:

A total of $952 for a hospital stay of 1-60 days.
$238 per day for days 61-90 of a hospital stay.
$476 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
All costs for each day beyond 150 daysSkilled Nursing Facility Coinsurance

$119.00 per day for days 21 through 100 each benefit period.Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)

$124.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $124.00 deductible.)

charlesjain
11-08-2006, 03:13 AM
What is Medicare prescription drug coverage?
Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription drugs at participating pharmacies in your area. Medicare prescription drug coverage provides protection for people who have very high drug costs.

Who can get Medicare prescription drug coverage?
Everyone with Medicare is eligible for this coverage, regardless of income and resources, health status, or current prescription expenses.

When can I get Medicare prescription drug coverage?
You may sign up from November 15, 2006 to December 31, 2006. Your coverage will start January 1, 2007. If you don't sign up when you are first eligible, you may pay a penalty. Your next opportunity to enroll will be from November 15, 2007 to December 31, 2007. Enrolling by December 8, 2006, can help ensure you can use your coverage as soon as you need it after it starts.

How does Medicare prescription drug coverage work?
Your decision about Medicare prescription drug coverage depends on the kind of health care coverage you have now. There are two ways to get Medicare prescription drug coverage. You can join a Medicare prescription drug plan or you can join a Medicare Advantage Plan or other Medicare Health Plan that offers drug coverage.

Whatever plan you choose, Medicare drug coverage will help you by covering brand-name and generic drugs at pharmacies that are convenient for you.

Like other insurance, if you join, generally you will pay a monthly premium, which varies by plan, and a yearly deductible (between $0-$265 in 2007). You will also pay a part of the cost of your prescriptions, including a copayment or coinsurance. Costs will vary depending on which drug plan you choose. Some plans may offer more coverage and additional drugs for a higher monthly premium. If you have limited income and resources, and you qualify for extra help, you may not have to pay a premium or deductible.

Why should I get Medicare prescription drug coverage?
Medicare prescription drug coverage provides greater peace of mind by protecting you from unexpected drug expenses. Even if you don't use a lot of prescription drugs now, you should still consider joining. As we age, most people need prescription drugs to stay healthy. For most people, joining now means protection from unexpected prescription drug bills in the future.

What if I have a limited income and resources?
There is extra help for people with limited income and resources. Almost 1 in 3 people with Medicare will qualify for extra help. Medicare will pay for almost all of their prescription drug costs.

charlesjain
11-08-2006, 03:20 AM
Glossary


Term Definition Annual Deductible
The amount you must pay for your prescriptions, before your Medicare drug plan begins to pay. These amounts can change every year.

If "Under Review" appears, it means that the prescription drug coverage is still being discussed by Medicare and the plan.

Approval Status
If Medicare has approved the coverage and costs offered by the company for the year 2007. “As submitted by organization” means the company has a current contract with Medicare, but Medicare is still discussing the coverage and costs offered by the company for 2007.

Cobrand
Refers to the partner relationships established between Medicare Prescription Drug Plans and other organizations. Some drug plans enter into agreements with other organizations to help market their drug plans. These relationships are between the drug plan and the partner organizations and are outside of the contract with Medicare.

Coinsurance
The amount you may be required to pay for services after you pay any plan deductibles. In the Original Medicare Plan, this is a percentage (like 20%) of the Medicare approved amount.
You have to pay this amount after you pay the deductible for Part A and/or Part B. In a Medicare Prescription Drug Plan, the coinsurance will vary depending on how much you have spent.

Copayment
In some Medicare health and prescription drug plans, the amount you pay for each medical service, like a doctor’s visit, or prescription. A copayment is usually a set amount you pay. For example, this could be $10 or $20 for a doctor’s visit or prescription. Copayments are also used for some hospital outpatient services in the Original Medicare Plan.

Company Name
Name of company that contracts with Medicare to offer a Medicare Prescription Drug Plan. (The number next to the name is for Medicare’s use only.)

Cost Sharing
The amount you pay for health care and/or prescriptions. This amount can include copayments, coinsurance, and/or deductibles.

Coverage Gap
After you have spent a certain amount of money for covered drugs (no more than $2,400), you have to pay all costs for your drugs while you are in the “gap.” This amount doesn’t include your plan’s monthly premium, that you must continue to pay even while you are in the coverage gap. The coverage gap is sometimes called the "donut hole,"

Some Medicare drug plans offer a discount during the coverage gap.

Note: if you get extra help paying your drug costs, you won’t have a coverage gap. However, you will have to pay a small copayment or coinsurance amount.

Deductible
The amount you must pay for health care or prescriptions, before the Medicare drug plan begins to pay. These amounts can change every year.

Demonstration/Pilot Program
Special projects that test improvements in Medicare coverage, payment, and quality of care. Some follow Medicare Advantage rules, but others don’t. Demonstrations are usually for a specific group of people and/or are offered only in specific areas. There are also pilot programs for people with multiple chronic illnesses designed to reduce health risks, improve quality of life, and provide savings.

Employer or Union Retiree Plans
Health plans that give health coverage to employees, former employees, and their families. These plans are offered to people through their (or a spouse’s) current or former employer or employee organization.

Favorites
Your "favorites" are plans that you’re interested in. When you’re trying to decide which plan to join, you can create a list of plans you’re interested in so that you can return to the Medicare Prescription Drug Plan Finder later and still be able to see those plans. To add or remove plans from your list of "favorites", click the "Add" or "Remove" buttons on the right side of screen under the "favorites" column.

Formulary
A list of drugs covered by a plan

Generic Drug
A prescription drug that has the same active-ingredient formula as a brand-name drug. Generic drugs usually cost less than brand-name drugs. The Food and Drug Administration (FDA) rates these drugs to be as safe and effective as brand-name drugs.

Health Maintenance Organization (HMO)
A type of Medicare Health Plan that is available in most areas of the country. Plans must cover all Medicare Part A and Part B health care. Some HMOs cover extra benefits, like extra days in the hospital. In most HMOs, you can only go to doctors, specialists, or hospitals on the plan’s list except in an emergency. Your costs may be lower than in the Original Medicare Plan.

If I Qualify for Extra Help, will My Full Premium be Covered?
If $0 appears under the premium column, it means that the extra help you are receiving will cover the premium for that plan. If an amount of $1 or greater appears under the premium column, it means you will have to pay part of the premium because the extra help won’t cover all of it. You would be responsible for paying this monthly amount if you choose to enroll in that plan.

Medicaid
A joint federal and state program that helps with medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.

Medicare Advantage Plan

Health plan options that are approved by Medicare but run by private companies. They are part of the Medicare Program.

With Medicare Advantage Plans:
You generally get all your Medicare-covered health care through that plan.
Coverage can include prescription drug coverage.
You may get extra benefits, such as coverage for vision, hearing, dental, and/or health and wellness programs.
You may have lower out-of-pocket costs than the Original Medicare Plan.
You may have to use the plan’s doctors and hospitals to get services.You don’t need to buy a Medigap policy.


Medicare Cost Plan
A Medicare Cost Plan is a type of HMO. These plans may work in much the same way, and have some of the same rules, as Medicare Advantage Plans. In a Medicare Cost Plan, if you go to a non-network provider, the services are covered under the Original Medicare Plan. You would pay the Medicare Part A and Part B coinsurance and deductibles.

Medicare Health Plan
A plan offered by a private company that contracts with Medicare to provide you with your Medicare Part A and Part B benefits, and in most cases, Part D prescription drug benefits. Medicare Health Plans include Medicare Advantage Plans (including HMO, PPO, or Private Fee-for-Service Plans); Medicare Cost Plans; PACE plans; Special Needs Plans; and Demonstrations/Pilot Programs.

Medicare Medical Savings Account(MSA)Plan
A type of Medicare Advantage Plan. Medical Savings Account (MSA) Plans have two parts. The first part is a high-deductible Medicare Advantage MSA Health Plan. This health plan won’t begin to pay covered costs until you have met the annual deductible, which varies by plan. The second part is a Medical Savings Account into which Medicare deposits money that you may use to pay health care costs.

Medicare Prescription Drug Plan
A stand-alone drug plan, offered by insurers and other private companies to people with Medicare who receive benefits through the Original Medicare Plan; through a Medicare Private Fee-for-Service Plan that doesn’t offer prescription drug coverage; or who have a Medicare Cost Plan, or Medicare Medical Savings Account Plan. Medicare Advantage Plans may also offer qualified prescription drug coverage that must follow the same rules as Medicare Prescription Drug Plan.

Medicare Savings Program
Medicaid programs that help pay some or all Medicare premiums and deductibles.

Medicare Special Needs Plan

A special type of Medicare Advantage Plan that provides all Medicare Part A and Part B health care and services to people who can benefit the most from things like special care for chronic illnesses, care management of multiple diseases, and focused care management. These plans may limit membership to people
in certain institutions (like a nursing home),
eligible for both Medicare and Medicaid, orwith certain chronic or disabling conditions.


Monthly Premium
The periodic payment to Medicare, an insurance company, or a health care plan for health care or prescription drug coverage. In a few cases, a note will say “Under Review” instead of a premium amount. This means Medicare and the company are still discussing the amount.

Non-preferred pharmacy
A network pharmacy that offers covered drugs to plan members at higher out-of-pocket costs than what the member would pay at a preferred network pharmacy.

Original Medicare Plan
A fee-for-service health plan that lets you go to any doctor, hospital, or other health care supplier who accepts Medicare and is accepting new Medicare patients. You must pay the deductible. Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance). In some cases you may be charged more than the Medicare approved amount. The Original Medicare Plan has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance).

PACE (Programs of All-inclusive Care for the Elderly)

PACE combines medical, social, and long-term care services for frail people who live and get health care in the community. They are a joint Medicare and Medicaid option in some states. To be eligible, you must:
Be 55 years old, or older,
Live in the service area of the PACE program,
Be certified as eligible for nursing home care by the appropriate state agency , and
Be able to live safely in the community.The goal of PACE is to help people stay independent and live in their community as long as possible, while getting high quality care they need.


Part A (Hospital Insurance)
The part of Medicare that pays for inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care.

Part B (Medical Insurance)
Medicare medical insurance that helps pay for doctors' services, outpatient hospital care, durable medical equipment, and some medical services that are not covered by Part A.

Plan Name
The name of the plan offered by the company that contracts with Medicare.

Preferred Pharmacy
A network pharmacy that offers covered drugs to plan members at lower out-of-pocket costs than what the member would pay at a non-preferred network pharmacy.

Preferred Provider Organization
A type of Medicare Advantage Plan available in a local or regional area in which you pay less if you use doctors, hospitals, and providers that belong to the network. You can use doctors, hospitals, and providers outside of the network for an additional cost.

Prior Authorization
Prior approval from an insurance plan before you get care or fill a prescription. In many instances, your doctor or health care provider must first contact the plan and show there is a medically-necessary reason why you must use that particular drug for it to be covered.

Private Fee-for-Service Plan
A type of Medicare Health Plan in which you may go to any Medicare-approved doctor or hospital that accepts the plan’s payment. The insurance plan, rather than the Medicare Program, decides how much it will pay and what you pay for the services you get. You may pay more or less for Medicare-covered benefits. You may have extra benefits the Original Medicare Plan doesn’t cover.

Qualified Medicare Beneficiary (QMB)
A Medicaid program for people with Medicare who need help in paying for Medicare services. The person with Medicare must have Medicare Part A and limited income and resources. For those who qualify, the Medicaid program pays Medicare Part A and Part B premiums, and Medicare deductibles and coinsurance amounts for Medicare services.

Quantity Limitation
For safety and cost reasons, plans may limit the quantity of drugs that they cover over a certain period of time.

Specified Low - Income Medicare Beneficiary (SLMB)
A Medicaid program that pays for Medicare Part B premiums for individuals who have Medicare Part A, a low monthly income, and limited resources.

Step Therapy
In some cases, plans require you to first try one drug before they will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, a plan may require your doctor to prescribe Drug A first. If Drug A does not work for you, then the plan will cover Drug B.

Tiers
Drugs on a formulary are often organized into different drug “tiers,” or groups of different drug types. Your cost depends on which drug tier your drug is in.

For example, a plan may form tiers this way:
Tier 1 – Generic drugs.
Tier 2 – Preferred brand-name drugs.
Tier 3– Non-preferred brand name drugs.Contact the plan to learn more about its specific tier structure.

try to pass
11-08-2006, 04:56 PM
check this link for medicare part c
http://www.miconline.com/t527.htm

charlesjain
11-08-2006, 05:17 PM
Medicare Part D (Top 10 Facts)



Medicare Part D is the new prescription drug program that began January 1, 2006 and is available to any person previously eligible for Medicare Part A or enrolled in Part B.
Individuals can elect to enroll in Medicare Part D as a stand-alone prescription drug plan or integrated with a Medicare Advantage HMO, PPO or PFFS plan.
Medicare Part D is an optional insurance plan administered by private insurance companies. All patients who sign up for Part D will be protected from catastrophic expenses and many will save money by signing up.
Choosing which plan to enroll in is a difficult and complex decision. Seniors should investigate a variety of plans in their area and consider premiums, co-pays, formularies and pharmacies before making a decision.
Patients can enroll in Medicare Part D through an insurance company, Medicare or a licensed commercial agency.
The open enrollment period for Medicare Part D started on November 15, 2005 and will end on May 15, 2006. Coverage for Prescription drugs started on January 1, 2006 or begins the month following enrollment.
Eligible individuals who choose not to enroll during open enrollment will face a penalty when they do enroll unless they are currently enrolled in a plan that has Creditable Coverage.
Enrollees can change their qualified prescription drug coverage only during their annual open enrollment.
Medicare Part D provides additional assistance for low-income individuals. Individuals should contact their local social security office to apply for additional assistance.
Individuals enrolled in both Medicare and Medicaid have been automatically enrolled into a Part D plan by their state agency, but the individual may choose to select a different plan.

charlesjain
11-08-2006, 05:23 PM
MEDICARE PART D

Medicare Part D is a new prescription drug insurance program which has been available since January 1, 2006. It is a voluntary, highly subsidized, guaranteed enrollment, prescription drug insurance plan administered by private health insurance companies. Many companies bid for the right to work with Medicare as Part D administrators. As with other insurance plans, the Medicare recipient will pay a monthly premium and a share of the cost of the prescription drugs.
Medicare Part D is administered in two ways:

A stand-alone Prescription Drug Plan (PDP)
Integrated with medical coverage as a Medicare Advantage Prescription Drug plan (MA-PD). Patients can add a PDP policy to traditional Medicare Part A and/or B, or any medical only insurance supplemental policy. MA-PDs replace both supplemental medical and prescription drug coverage. All PDPs and MA-PDs must adhere to standards set forth by Medicare to ensure reasonable drug coverage.Who qualifies for Medicare Part D?

Any individual that is eligible for or enrolled in Medicare Part A and/or enrolled in Medicare Part B is entitled to participate in Medicare Part D. This includes people aged 65 and older, and some younger people with disabilities. Additionally, individuals currently enrolled in Medicaid (Medi-Cal in California) and Medicare (Dual Eligibles) are entitled to Medicare Part D drug benefits. Unlike other insurance plans, one cannot be denied coverage for health reasons.

Individuals who are currently covered by other “Creditable” coverage cannot enroll into Part D without leaving the other plan. Creditable coverage is defined as coverage at least as good as a Medicare Part D plan. Additionally, Medigap recipients cannot enroll into Medicare Part D and maintain their prescription drug plan simultaneously. Patients should receive information from their plan administrator as to whether their plans qualify as Creditable Coverage. If they don't receive this information, they should follow-up directly with that plan.

What drugs are covered?

Medicare Part D includes most prescription drugs not currently covered under Medicare Part A and B. Examples of Part A and Part B drugs are those drugs administered in a hospital or doctor's office. Vaccines and certain biologics are covered.

What drugs are excluded?

The following are some of the types of drugs excluded from Part D by Medicare:

Drugs to promote fertility
Drugs for weight loss or gain
Drugs for cosmetic purposes
Drugs for relief of simple coughs and colds
Prescription vitamin and mineral products
Non-prescription drugs
Inpatient drugs
Barbiturates
Benzodiazepines

fafy
11-08-2006, 06:43 PM
WHAOH thanks it's so much helpful!!!! :tup: