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Frequently Asked Questions

What is Medicare?

In Michigan and all other states: Medicare is a health insurance Program for: people age 65 or older; people under age 65 with certain disabilities; people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).Medicare has Two Parts: Part A (Hospital Insurance) most people don’t have to pay for Part A; Part B (Medical Insurance) most people pay monthly for Part B insurance. You can choose different ways to get the services covered by Medicare. Depending on where you live, you may have different choices. In most cases, when you first get Medicare, you are in Original Medicare. You may want to consider a Medicare Prescription Drug Plan to add drug coverage. Or, you may want to consider a Medicare Advantage Plan (like HMO or PPO) that provides all your Part A, and Part B, and often Part D coverage. You make a choice when you are first eligible for Medicare. Each year you can review your health and prescription needs and switch to a different plan in the fall. As long as you have both Part A and Part B, items covered by Part A and Part B are covered whether you have Original Medicare, or you belong to a Medicare Advantage Plan (like an HMO or PPO).

If you have Medicare A&B then in Michigan, you are eligible to buy a Medicare Supplement or Medicare Advantage Plan.

Who is Eligible for Medicare?

In Michigan and all other states: you are generally eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years or older and a citizen or permanent resident of the United States, if you aren’t yet 65, you might also qualify for coverage if you have a disability or with End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant).
Here are some simple guidelines; you can get Part A insurance at age 65 without having to pay premiums if: You already get retirement benefits form Social Security or the Railroad Retirement Board. You are eligible to get Social Security or Railroad benefits but haven’t yet filed for them. You or your spouse had Medicare-covered government employment.

If you are under 65, you can get Part A insurance without having to pay premiums if you have: received Social Security or Railroad Retirement Board disability benefits for 24 months. End-Stage Renal Disease and meet certain requirements.

While you don’t have to pay a premium for Part A insurance if you meet one of those conditions, you must pay for Part B if you want it.
If you have Medicare A&B then in Michigan, you are eligible to buy a Medicare Supplement or Medicare Advantage Plan.

What is the Difference Between Medicare Part A and B?

In Michigan and all other states:Part A (Hospital Insurance) Helps pay for: Care in hospitals as an inpatient, critical access hospitals, skilled nursing facilities (not custodial or long-term care), hospice care, and some home health care. Information about your coverage under Medicare Part A can be found in the Your Medicare Coverage database. If you aren’t sure if you have Part A, look on you red, white, and blue Medicare card. If you have Part A, “HOSPITAL (PART A)” is printed on your card.

Cost: Most people get Part A automatically when they turn age 65. They don’t have to pay a monthly payment called a premium for Part A because they or a spouse paid Medicare taxes while they were working. If you don’t automatically get premium-free Part A, you may be able to buy it if; You (or your spouse) aren’t entitled to social Security because you don’t work or didn’t pay enough Medicare taxes while you worked and you are age 65 or older, or you are disabled but no longer get premium-free Part A because you returned to work. If you have limited income and resources, your state may help you pay for Part A and/or Part B. for more information, visit www. Socialsecurity.gov on the web or call Social Security at 1-800-772-1213.

Part B (Medical Insurance) Helps pay for: Doctors’ services, outpatient hospital care, and some other medical services that Part A doesn’t cover, such as the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

Cost: Most Medicare beneficiaries will pay $100+ for theirPart B premium amount in 2013. Beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium and have incomes of $85,000 or less (or $170,000 or less for joint filers) will not have an increase in their Part B premium for 2013. To get specific information on your premiums, based on your income level, please call our office.

If you have Medicare A&B then in Michigan, you are eligible to buy a Medicare Supplement or Medicare Advantage Plan.

How Do I Get Medicare Part A and Part B?

In Michigan and all other states: Many People Automatically Get Medicare Part A and Part B insurance; if you’re already collecting benefits form Social Security or the Railroad Retirement Board (RRB); you will automatically get Part A (Hospital Insurance) and Part B (Medical Insurance). If you get Part B automatically and you don’t want to keep it, you must follow Medicare’s directions to let Medicare know you don’t want it. Otherwise, you’ll be charged the Part B premium.

Some People Need to Sign Up for Part A and Part B insurance; If you’re age 65 or older and you aren’t getting Social Security or RRB benefits yet (for instance, because you’re still working), you won’t get Part A and Part B automatically: you need to sign up for them. If you worked for a railroad, contact the RRB to sign up. Everyone else should contact Social Security to sing up for Pat A and Part B.

Note about Part A Premiums; most people don’t pay a monthly premium for Part A coverage because they (or their spouse) paid Medicare taxes while they were working. This is called “premium-free Part A.” People who aren’t eligible for premium-free Part A may be able to buy Part A for a monthly premium if they meet certain eligibility requirements. In most cases, if you want to buy Part A this way, you must also have Part B, which means you’ll have to pay the monthly Part B premium, too.

If you have Medicare A&B then in Michigan, you are eligible to buy a Medicare Supplement or Medicare Advantage Plan.

When Can I Sign Up for Medicare Part A and Part B?

In Michigan and all other states: If you didn’t sign up for Part A and/or Part B when you first became eligible, you can sign up during the following times: You can sign up for Part A and /or Part B during the General Enrollment Period between January 1-March 31 each year, with coverage starting July 1. (You may have to pay a higher premium for late enrollment.)

You can sign up for Part A and Part B with out a penalty anytime that you or your spouse (or family member if you’re disabled) are working, and you’re covered by a group health plan through the employer or union based on that work. If that coverage ends, you can sign up during the 8-month period that begins the month after the employment ends or the group health plan coverage ends, whichever happens first. This is your Special Enrollment Period (SEP)

If you have Medicare A&B then in Michigan, you are eligible to buy a Medicare Supplement or Medicare Advantage Plan.

What is Medicare Prescription Drug Coverage (Part D) and How Can I Get It?

In Michigan and all other states:Medicare offers prescription drug coverage (Part D) for everyone with Medicare. To get Medicare drug coverage, you must join a plan run by aninsurance company or other private company approved by and under contract with Medicare. Each plan can vary in cost and drugs covered. If you want Medicare drug coverage, you need to choose a plan that works with your health coverage.

There are two ways to get Medicare prescription drug coverage: Medicare Prescription Drug Plans. These plans (sometimes called “PDPs“) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service Plans, and Medicare Medical Savings Account Plans.

Medicare Advantage Plans (like an HMO or PPO) or other Medicare health plans that have prescription drug coverage. You will get all of your Part A and Part B insurance coverage and prescriptions drug coverage (Part D) through these plans. Medicare Advantage Plans with prescriptions drug coverage are sometimes called “MA-PDs.”

If you have Medicare A&B then in Michigan, you are eligible to buy a Medicare Supplement or Medicare Advantage Plan.

What is the Difference Between Original Medicare and Medicare Advantage?

In Michigan and all other states:, you can choose how you get your health and prescription drug coverage. Original Medicare;run by the Federal government. Provides your Part A and Part B coverage. You can join a Medicare Prescription Drug Plan (Part D) to add drug coverage. You can buy a Medigap (Medicare Supplement Insurance) policy (sold by private insurance companies) to help fill the gaps in Part A and Part B coverage (like coinsurance, copayments, and deductibles.)

Medicare Advantage Plans (like an HMO or PPO); run by private insurance companies approved by Medicare. Provide your Part A and Part B insurance coverage, but can charge different amounts for certain services. May offer extra coverage and prescription drug coverage for an extra cost. Costs for items and services vary by plan. If you want drug coverage, you must get it through your plan (in most cases). You don’t need a Medigap policy.

If you have Medicare A&B then in Michigan, you are eligible to buy a Medicare Supplement or Medicare Advantage Plan.

What is the Difference Between Medicare Supplement and Medicare Advantage Plans?

Medigap (also called “Medicare Supplement Insurance”) policies are health insurance sold by private insurance companies to fill gaps in Original Medicare coverage. Medigap policies don’t work with any other type of health insurance, including Medicare Advantage Plans, employer/union group coverage, Veterans Administration (VA) benefits, or TRICARE. Medigap policies help pay your share (coinsurance, copayments, or deductibles) of the costs of Medicare-covered services. Some Medigap policies cover certain costs not covered by Original Medicare.

Medicare Advantage Plans (like an HMO or PPO); run by private insurance companies approved by Medicare. Provide your Part A and Part B coverage, but can charge different amounts for certain services. May offer extra coverage and prescription drug coverage for an extra cost. Costs for items and services vary by plan. If you want drug coverage, you must get it through your plan (in most cases). You don’t need a Medigap policy.

If you have Medicare A&B then in Michigan, you are eligible to buy a Medicare Supplement or Medicare Advantage Plan.

What is the Difference Between Medicare Insurance and Medicare Supplement?

In general terms Medicare “Insurance” could mean Both a Medicare Advantage Plan or Medicare Supplement. When someone buys a Medicare Advantage Plan or Medicare Supplement insurance they are buying something that either replaces or supplements Original Medicare.

If you have Medicare A&B then in Michigan, you are eligible to buy a Medicare Supplement or Medicare Advantage Plan.

How Will Medicare Change Under Healthcare Reform (AKA Obamacare)?

1. Closing the “donut hole.”

That’s the nickname for the coverage gap that occurs in some Medicare Prescription Drug Plans. Once costs for prescription medicines reach a certain amount, you enter the donut hole. The Affordable Care Act, which went into effect on March 23, 2010, created the “Medicare Prescription Coverage Gap Discount Program” to help fill that gap. It provides manufacturer discounts of 50% on covered brand-name drugs. If you’re a Medicare member, the system keeps track of how much you spend on medications and the discounts are automatic once you reach the coverage gap.

Note: Not all brand-name drugs are covered under these benefits. Only the drug companies that agree with the terms and conditions of the Centers for Medicare and Medicaid Services (CMS) work with Medicare plans.

There are also discounts for those who prefer to buy lower-cost generic prescription medications while in the doughnut hole. Medicare beneficiaries with Plan D coverage get a discount of 21% on generic prescription drugs in 2013, and 28% in 2014 (up from 14% in 2012).

2. Changes in Enrollment Periods.

In the past, people with Medicare enrolled in Medicare Advantage (MA) and Prescription Drug Plans (PDP) from October 15 through December 7 — called the Annual Election Period (AEP) — for the following year’s coverage. Your plan selection became effective on January 1. There were rules in place if you wanted to change your MA plan or prescription drug coverage on or after the first of the year. Now that’s changed and there’s a time called the Annual Disenrollment Period (ADP).

Starting in 2013, the ADP is January 1 through February 14 each year. During this time, people who have a Medicare Advantage plan are able to drop their MA coverage and go back to Original Medicare. You will not be able to enroll in a different Medicare Advantage plan, but you can enroll in a stand-alone prescription drug plan.

3. Preventive Care Benefits.

Some of the law’s changes emphasize preventive care to help people of all ages stay healthy. Seniors are eligible for annual wellness checkups, vaccines and flu shots, cancer screenings and more without cost-sharing. Check with your plan to see if qualify.

Why call anyone else? We can answer all these questions and more.

We can help you find the best Medicare Supplement or Medicare Advantage plan at no cost to you.





Hoover and Associates Proudly Represents The Following Medicare Insurance Providers:

Blue Cross and Blue Shield of Michigan

Blue Care Network of Michigan

HAP – Health Alliance Plan

United Health Care

Mutual of Omaha

Priority Health

Gerber Life