Monthly Archives: July 2015

Medicare Part B Explained

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What is Medicare Part B?

In general, your Medicare insurance is divided into three parts; Part A, Part B and Part D.  The simplest descriptions of Medicare refer to Part A as inpatient hospital coverage and Medicare Part B as outpatient coverage.  While technically correct, the details are where many Medicare beneficiaries get caught misunderstanding their coverage, resulting in surprise billings that could have been avoided.  Our recent article on Part A covered what to look out for and expect from that portion of coverage.  We hope to do the same with Medicare Part B in this article so that our readers are forewarned and forearmed.

To understand Medicare it may be best to first look at the contracts between healthcare providers and the Medicare insuranceCenter for Medicare and Medicaid Services (CMS) which is that portion of the Department of Health and Human Services (HHS) that manages Medicare.

All insurance organisations have negotiated rates for medical services.  Medicare has negotiated medical services down to between 15% and 18% of non-negotiated prices.  That means that if there were a medical procedure that would cost $1,000 before negotiation, the Medicare-participating doctor has agreed to accept Medicare’s rate of between $150 and $180 for that service.  More on this later in our next article on the difference between Participating and Nonparticipating providers.

Medicare Part B covers outpatient services, doctor services, lab work, home health care and Wellness care.  In everything it covers, Part B will either pay 80% or 100% of the approved negotiated rate after the annual deductible is paid. The exception to this is Wellness service which is covered 100% and does not require the deductible to be paid.


Medicare Part A

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With over 70% of seniors in the United States participating, original Medicare remains the top healthcareMedicare Part A Part B program in the country.  Because seniors can choose any doctor that takes Medicare without having to consider networks or referrals, Original Medicare offers seniors more freedom of choice than any alternative Advantage program. In addition, because virtually every medically necessary medical procedure is covered by either Medicare Part A or Medicare Part B, seniors using Original Medicare do not have to worry about their insurance program denying coverage.  As long as you and your doctor believe it is necessary, the odds are your Original Medicare will cover it. In this article, we answer the question; what is Medicare Part A?

Original Medicare has three basic parts; Part A, Part B and Part D.  In general, Part A covers inpatient hospital care, Part B covers outpatient care and Part D covers prescription drugs.  This article focuses on Medicare Part A which seems the simplest, but is in fact the most misunderstood part of Original Medicare.

Medicare Part A covers:

  • inpatient hospital care,
  • skilled nursing,
  • nursing home care,
  • hospice and home health services.

Part A MedicareMost insurance agents simply explain that Medicare Part A is your inpatient hospital coverage and Medicare Part B is outpatient coverage.  While that is technically true, it ignores the potential pitfalls and surprises are in the details of the plans.   Part A operates very differently that Part B.  It’s in these details that Part A is misunderstood and can lead to surprises and significant unexpected health costs for the Medicare beneficiary.

Medicare Part A offers health insurance coverage in time units called “Benefit Periods”.  A benefit period begins the day you are admitted as an inpatient in a hospital.  The benefit period ends when you have not been an inpatient in either a hospital or skilled nursing facility for 60 consecutive days. You can have an unlimited number of benefits periods.  Note: your skilled nursing benefits only take effect after you have a qualifying hospital stay (i.e. an admitted inpatient for 3-days)


Lower Your Medigap Insurance Premium

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    Are your Medicare Supplement premiums increasing again?!  

     If you could lower your Medicare Supplement premiums by 25%, 30% or more without reducing or even changing your Medicare Supplement benefits, would you?

    According to recent statistics; nearly 8 in 10 seniors are overpaying for the Medicare Supplement plan by an average of between $400 and $1,000 per person.  The odds are you can lower your Medicare Supplement plan prices by your next monthly payment, and keep the same benefits you have now.  There is no waiting for Open Season like there is with Medicare Advantage plans.  It cost you nothing to find out how much you can save and how easy it is to lower your monthly premium right now.  Complete the quote request today and we will find the best price for your Medicare Supplement plan and email you back how much you can save!

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Medicare Part D Donut-Hole Explained

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This graphic linked below does a great job of helping people understand the Medicare Part D Donut-Hole. This Medicare Part D donut hole explained infographic can be saved and printed.

If you regularly take a significant number of prescriptions, or expensive prescriptions, it is critical that you understand the coverage gap concept.  If you would like to know why we suggest you never buy your Medicare Part D coverage from a broker or agent, visit one of our online presentations or call us at 800-847-9680.

Especially if you take more than a few prescriptions each month, the only way you can be certain that you are getting the best Medicare Part D plan at the best price is to avoid purchasing your plan from a broker or agent. There are some Part D plans offered through that are not available through your agent.

We show you how to go about getting the right pan in 15 minutes or less!

There are other ways to avoid the donut hole as well.  Just ask!