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Choosing the coverage and the doctors that are right for you and your specific needs takes education, review, and an understanding of what can seem like a complex process.

Matts California Health Insurance Services prides itself on simplifying the complexity and putting you on a path to a more secure senior life. Please contact us today so we may review all your needs and requirements, Let us put you
in control of your Medicare Supplement Insurance.

Secure Horizons® Plans and Aetna Advantage Plans are also available. To get more information email me Matt@MattsInsurance4CA.com or call (866) 861-0477 for an enrollment kit and applications.

Making sense of Medicare Parts in California


Finding a Medicare Supplement Plan to suite your needs can be a stressful, time-consuming process. Deciphering between Medicare part A, part B, part C, and part D are not so tough but then you find out  the different Medicare Supplement plans offered are identified with the letters A through J. That’s when most people find themselves at their wit's end. If you are venturing into the world of Medicare Supplements for the first time, know that you are not alone and that with some savvy maneuvering, you too can find a suitable health care plan.
Below is a series of questions and answers to help you better understand the parts of Medicare. If you want help making sense of it all, Matt Lockard can help.  Matt Lockard is an independent California health insurance agent in Ventura California. At MattsInsurance4CA.com you can use a quoting tool to access California’s leading Medicare Supplement insurance plans and prices. We lay out choices for you in an easy-to read and easy to understand manner. 
 Matt Lockard has over 15 years of experience in the California health insurance industry, and will put that experience to work for you. Our number one goal is to make sure that you get the insurance you need at a price you can afford. I’m located in Ventura California and can best help you by phone at 1-866-861-0477 M-F 9am-7pm PST, but I welcome your questions by e-mail as well.

What is Medicare?
Medicare is a federal health insurance program for people age 65 and older, people of any age with permanent kidney failure, and certain disabled people under age 65. Medicare is managed by the Centers for Medicare and Medicaid Services (CMS), which is part of the Department of Health and Human Services.

Medicare Is a Health Insurance Program for:
 People 65 years of age and older
 Certain younger people with disabilities
 People with End-Stage Renal Disease (people with permanent kidney failure who need dialysis or a transplant).

Who is Eligible for Medicare?


Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States.  You might also qualify for coverage if you are a younger person with a disability or with chronic kidney disease.


Here are some simple guidelines.

  • You can get Part A at age 65 without having to pay premiums if: 
  • You are already receiving retirement benefits from Social Security or the Railroad Retirement Board. 
  • You are eligible to receive Social Security or Railroad benefits but have not yet filed for them. 
  • You or your spouse had Medicare-covered government employment.


If you are under 65, you can get Part A without having to pay premiums if:

  • You have received Social Security or Railroad Retirement Board disability benefits for 24 months. 
     
  • You are a kidney dialysis or kidney transplant patient.

While you do not have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it.  The Part B monthly premium in 2009 is $96.40 per month*.  It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check.

If you have questions about your eligibility for Medicare Part A or Part B, or if you want to apply for Medicare, call the Social Security Administration.  The toll-free telephone number is: 1-800-772-1213.   The TTY-TDD number for the hearing and speech impaired is 1-800-325-0778.  You can also get information about buying Part A as well as part B if you do not qualify for premium-free Part A.

 

What is the Original Medicare Plan?


The Original Medicare Plan is the traditional pay-per-visit arrangement. You can go to any doctor, hospital, or other health care provider who accepts Medicare.  You must pay the deductible. Then Medicare pays its share, and you pay your share (coinsurance). The Original Medicare Plan has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). If you are in the Original Medicare Plan now, the way you receive your health care will not change unless you enroll in another Medicare health plan.

 

Medicare Parts A, B, C and D
Medicare is divided into four parts: Part A, Part B, Part C and Part D.

 

What is Part A (Hospital Insurance)?
Part A (Hospital Insurance) helps pay for care in hospitals and skilled nursing facilities, and for home health and hospice care. If you are eligible, Part A will be premium free -- that is, you don't pay a premium because you or your spouse paid Medicare taxes while you were working. Your SHIP Counselor will be able to help you answer many of your questions.  Please call (702) 486-3478 or (800) 307-4444.
You are eligible for premium-free Medicare Part A (Hospital Insurance) if:

  • You are 65 or older. You are receiving or eligible for retirement benefits from Social Security or the Railroad Retirement Board, or
  • You are under 65. You have received Social Security disability benefits for 24 months, or
  • You are under 65. You have received Railroad Retirement disability benefits for the prescribed time and you meet the Social Security Act disability requirements, or
  • You or your spouse had Medicare-covered government employment, or
  • You are under 65 and have End-Stage Renal Disease.

If you don't qualify for premium-free Part A, and you are 65 or older, you may be able to buy it. (Contact the Social Security Administration.)

  • 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 $244.00 per month for people having 30-39 quarters of Medicare-covered employment.
  • The Part A premium is $443.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.

What is Part B (Medical Insurance)?
Part B (Medical Insurance) helps pay for doctors, outpatient hospital care and some other medical services that Part A doesn't cover, such as the services of physical and occupational therapists. Part B covers all doctor services that are medically necessary. Beneficiaries may receive these services anywhere (a doctor's office, clinic, nursing home, hospital, or at home).
You are automatically eligible for Part B if you are eligible for premium-free Part A. You are also eligible if you are a United States citizen or permanent resident age 65 or older. Part B cost $96.40 per month* in 2009.  (See below.)

Part B is voluntary. If you choose to have Part B, the monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement payment. Beneficiaries who do not receive any of the above payments are billed by Medicare every 3 months.

If you didn't take Part B when you were first eligible, you can sign-up during 2 enrollment periods:  General Enrollment Period: If you didn't take Part B, you can only sign up during the general enrollment period, January 1 through March 31 of each year. Your Part B coverage is effective July 1. Your monthly Part B premium may be higher. The Part B premium increases 10% for each 12-month period that you could have had Part B but did not take it.

 Special Enrollment Period: If you didn't take Part B because you or your spouse currently work and have group health plan coverage through your current employer or union, you can sign up for Part B during the special enrollment period. Under the special enrollment period, you can sign up at any time you are covered under the group plan. In addition, if the employment or group health coverage ends, you have 8 months to sign up. The 8-month period starts the month after the employment ends or the group health coverage ends, whichever comes first. Generally, your monthly Part B premium is not increased when you sign up for Part B during the special enrollment period. Contact the Social Security Administration to sign up.

Medicare Part C: Medicare Advantage Plans
Part C governs the way Medicare benefits are provided by companies that contract with the Medicare program. Someone with Medicare who enrolls in a Medicare Advantage plan generally gets all of their medical services through that plan. Health Maintenance Organizations (HMO's) and Preferred Provider Organizations (PPO's) contract with Medicare to provide Medicare benefits in a managed care setting, that in 2006 will include the new Medicare Part D benefit in all but a few HMO's. Private Fee for Service plans (PFFS) and Medical Savings Accounts (MSAs) can contract with Medicare to provide Part A and B benefits through an insurance program. PFFS plans have the option of including the new Part D benefit while MSA plans are not allowed to. People enrolling in one of those plans without Part D benefits would need to buy separate coverage for that benefit.

Part D: Medicare Prescription Drug Coverage
Part D pays for prescription drugs. The coverage is voluntary and the monthly premium varies depending on how much coverage you have.

What Are Your "Out-of-Pocket" Costs?
The Original Medicare Plan pays for much of your health care, but not all of it. Your "out-of-pocket" costs for health care will include your monthly Part B premium. In addition, when you get health care services, you will also have to pay deductibles and coinsurance or co-payments. Generally, you will pay for your outpatient prescription drugs. You also pay for routine physicals, custodial care, most dental care, dentures, routine foot care, or hearing aids. Physical therapy and occupational therapy services, except for those you get in hospital outpatient departments, are subject to annual limits. The Original Medicare Plan does pay for some preventive care, but not all of it.

Your Out-of-Pocket Costs May Depend On:

  • Whether your doctor accepts assignment.
  • How often you need health care.
  • What type of health care you need.

If You Choose another Medicare Health Plan or Purchase a Supplemental Policy, Out-of-Pocket Costs May Also Depend On:

  • Which Medicare health plan you choose.
  • What extra benefits are covered by the plan?
  • What your supplemental health insurance covers.

Help for Low-Income Medicare Beneficiaries
For certain older, low-income or disabled individuals entitled to Medicare Part A, your State Medicaid program will pay some or all of Medicare's premiums, and may also pay Medicare's deductibles and coinsurance if you have Part A, and your bank accounts, stocks, bonds, or other resources do not exceed $4,000 for an individual, or $6,000 for a couple, you may qualify for assistance. For more information go to Medicaid.

Medicare Amounts for the Year 2009

INPATIENT HOSPITAL INSURANCE (PART-A):

  • A total of $1,068 for a hospital stay of 1-60 days.
  • $267 per day for days 61-90 of a hospital stay.
  • $534 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
  • All costs for each day beyond 150 days

SKILLED NURSING FACILITY COINSURANCE - $133.50 per day for days 21 - 100 each benefit period.

HOSPITAL INSURANCE (PART A) 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 $244.00 per month for people having 30-39 quarters of Medicare-covered employment.
  • The Part A premium is $443.00 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 DEDUCTIBLE:
$135.00 per year
(Note: You pay 20% of the Medicare-approved amount for services after you meet the $135.00 deductible.)

PART B MONTHLY PREMIUM

The 2009 Part B monthly premium rates to be paid by beneficiaries who file an individual tax return (including those who are single, head of household, qualifying widow(er) with dependent child, or married filing separately who lived apart from their spouse for the entire taxable year), or joint tax return are:

 You Pay

If Your Yearly Income is

 

 Single

  Married Couple 

 $96.40

 $85,000 or less

$170,000 or less

 $134.90

 $85,001-$107,000

$170,001-$214,000

 $192.70

 $107,001-$160,000

$214,001-$320,000

 $250.50

 $160,001-$213,000

$320,001-$426,000

 $308.30

 Above $213,000

Above $426,000

 

 You Pay

If You Are Married but You File a Separate Tax Return From Your Spouse and Your Yearly Income is

 $96.40

 $85,000 or less

 $250.50

 $85,001-$128,000

 $308.30

Above $128,000

In addition, the monthly premium rates to be paid by beneficiaries who are married, but file a separate return from their spouse and lived with their spouse at some time during the taxable year are:

*Note: If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $96.40 per month. 

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