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FAQ About Medicare Part A – Hospital Insurance

Now that you have some background information about Medicare Part A, here are some of the frequently asked questions about Medicare and all its parts. Speak with a Medicare insurance professional right away if you still need clarity on your coverages.

Medicare Part A normally doesn’t cover your full hospital bill and you will be responsible for a piece of the cost. You could have to pay a deductible before your Medicare benefits kick in. 

Upon payment of your deductible, then Medicare will pay 100% of your costs for up to 60 days in the hospital or up to 20 days in a skilled nursing facility. After your benefits are used, then you’ll pay a flat amount up to the maximum number of covered days. 

Medicare Part A benefits will cover some of the costs for up to 90 days in the hospital or 100 days in a skilled nursing facility. Medicare will also cover up to 60 lifetime reserve days. Lifetime reserve days are counted after you’ve stayed in a hospital for more than 90 days in a row. 

The majority of Medicare Part A beneficiaries don’t pay a monthly premium for coverage. This is also called “premium-free Part A.” Typically, when you (or your spouse) have worked at least 10 years and paid Medicare taxes while working, then you’re eligible for premium-free Part A. 

Medicare Part A covers hospital expenses. Doctor visits, medical services, and supplies are normally covered under Medicare Part B. 

Medicare Part A, also known as “hospital insurance,” covers the costs of an emergency room (ER) visit if you’re admitted to the hospital to treat the illness or injury that brought you to the ER. If your ER trip isn’t covered under your Medicare Part A plan, then you could be eligible to get coverage through Medicare Part B, C, D, or Medigap plans. 

Generally, there’s not a dollar limit on your Medicare benefits. If the coverage you desire falls within the parameters of what Medicare covers, and those services are medically necessary, then you can continue to use as much as you need for as long as you require. 

If you desire to disenroll from your Medicare Part A coverage, then you can fill out CMS form 1763 which is the Request for Termination of Premium Hospital and Medical Insurance, and mail it to your local Social Security Administration office.  

If you need to disenroll after the age of 65, then you will be required to pay back all of the money you’ve received from Social Security and any Medicare benefits paid on your behalf. You can always re-enroll by calling 1-800-772-1213 or visiting your local SSA office

FAQ About Medicare Part B Medical Insurance

Below are some of the most frequently asked questions about Medical Part B coverage and medical insurance. If you still have questions after reading this, then don’t hesitate to contact Emerald Insurance Agency for answers and support. 

Some people automatically receive Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage while others have to sign up. Your situation will more than likely depend on whether you’re getting Social Security benefits

Medicare is managed by the Centers for Medicare & Medicaid Services (CMS). Social Security collaborates with CMS to enroll people in Medicare. Each year you’re eligible to review your services and plans but you don’t have to renew your subscription to Medicare services. If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty.

You’ll only be eligible to sign up for Part B if you already have Medicare Part A (Hospital

Insurance). If you don’t have Part A and want to sign up, please contact Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778.

You can sign up for Part B during your Initial Enrollment Period (IEP) when you become

eligible for Medicare, during the General Enrollment Period (GEP) from January 1 through March 31 each year, and If you’re eligible for a Special Enrollment Period (SEP).

You can voluntarily stop your Medicare Part B (medical insurance) anytime however, you may have to have a personal interview. A Social Security representative or Arizona Insurance Professional can help you complete form CMS 1763 and terminate your services. 

To find out more about how to terminate Medicare Part B or to schedule a personal interview, contact the Social Security Administration at 1-800-772-1213 (TTY: 1-800-325-0778) between Monday through Friday from 8:00 am – 7:00 pm or contact your nearest Social Security office. Emerald Insurance Agency can also provide aid for your Medicare Part B inquiries. 

Each month you’ll pay a premium that will be automatically deducted from your Social Security, Railroad Retirement Board, or Office of Personnel Management benefits package. If you aren’t eligible for these benefits, then you’ll receive a bill. 

Most people pay the standard premium amount. When your modified adjusted gross income is above a certain amount, you’ll pay an Income Related Monthly Adjustment Amount (IRMAA). Medicare applies the modified adjusted gross income reported on your IRS tax return from 2 years ago because it is the most recent tax return information provided to Social Security by the IRS. 

If your other medical insurance is a COBRA policy, individual policy, or retiree coverage provided by a union or employer, then your enrollment in both Part A, hospital insurance, and Part B, medical insurance, is necessary. These types of coverages are billed secondarily to Medicare, and they’ll pay for any care that Medicare doesn’t cover.

People with Original Medicare get a Medical Summary Notice (MSN) in the mail every 3 months for their Medicare Part A and Part B-covered services. The MSN shows all the services or supplies those providers and supplier billed on your behalf to Medicare during the 3-month period, what Medicare paid, and the maximum amount you may owe the provider. 

Prescription Drug Coverage – Medicare Part D

Prescription drugs are an important component of medical treatment, and the costs can be coupled with your Medicare coverage plan. Medicare Part D specifically aids in the payment for prescription drugs. You may not currently need prescription drugs, but this type of coverage makes them more affordable if you ever do. There are different individual prescription drug plans that you can consider, and you can work with the Emerald Insurance Agency to discover which plan works best for you. Call us today to review your options. 

Background Information on Medicare Part D Prescription Drug Plans

Understanding what is included in the Medicare Part D plan will help you decide what works best for your Medicare coverage plan.

All plans under this insurance coverage include a broad range of prescription drugs typically taken by participants in the Medicare program. The majority of the drugs in the protected classes are covered as well. These include HIV/AIDs and cancer therapy drugs. Most generic drugs are covered by this plan. The Food and Drug Administration categorizes generic drugs as brand-name drugs or those that are similar to brand-name style formulas found in the same categories. This means that the same active ingredients found in brand-name prescription drugs are the ones that will need to be found in drugs covered by this plan. Every plan has its own formulary, which itemizes what particular drugs are included. Most Medicare plans will also place drugs into tier levels on their formularies to show which level of coverage covers which specific drugs. The lower tiers are less expensive than, the higher tiers but also include fewer prescription drugs. 

There are some medications that are not covered by this insurance plan. This includes prescriptions that are not typically utilized for a medically accepted reason. If it is not approved by the Food and Drug Administration, it won’t be covered either. It also won’t be included in the plan if it is sold outside of the United States, even if it is popular in another country. Lastly, the drug won’t be covered if it is sold over-the-counter and is a non-prescription drug. This can include fertility medications, cough syrup, cold medication, cosmetic medications, pills for sexual dysfunction, weight loss or gain medications, and also hair growth treatments. Nutritional supplements and vitamins are also not covered. If there is a medical condition for sexual dysfunction, this may be excusable and considered within prescription drug plans.

There is no best prescription drug plan, except one that works best for your particular circumstance. You can compare Medicare Part D Plans to help you choose. For example, if you take a lot of generic prescriptions, you can go through the tiers to understand which ones will cover what you need for the most affordable rate. If you take specific drugs, check the formulary list of each drug plan. If you need some help with the high costs of expensive drug prescriptions, you can pick a plan that has a coverage gap offer. This is so that it can cover your drugs during the gap between when you are and aren’t using them. For prescription drug plans for seniors, this works exceptionally well. If you would like lower costs and extra benefits, you can balance this with more restrictions on which hospitals and doctors you use. This would work for the Medicare Advantage Plan Part C with prescription drug coverage. If you want coverage just in case you need it in the future, and to avoid late penalties, you can enroll in a low monthly premium drug coverage program. 

When paying for a Part D premium it always goes by yearly income. When you make less than $88,000 individually and $176,000 jointly, you would only pay for your plan premium. When you make between $88,000 to $111,000 individually and $176,000 to $222,000 jointly, the plan will cost $12.30 plus the plan premium. If you make between $111,000 to $138,000 individually and $222,000 to $276,000 jointly, the plan will cost $31.80 plus the plan premium. In higher tiers, when you make between $138,000 to $165,000 individually and $276,000 to $330,000 jointly, the plan will cost $51.20 plus the plan premium. Also, when you make between $165,000 to $500,000 individually and $333,000 to $750,000 jointly, the plan will cost $70.70 plus the plan premium. Lastly, when you make above $500,000 individually and above $750,000 jointly, the plan will cost $77.10 plus the plan premium. 

To enroll in this coverage plan, you will have to enroll when you’re first eligible and applying for medical coverage of any kind. If you aren’t covered by another drug coverage, for example through a union, you will have to pay a late enrollment penalty for as long as you have the drug coverage. There are two ways to enroll. The first approach is to have Medicare Part A or Medicare Part B insurance coverage before you add on the drug coverage. The other approach is to have the Medicare Advantage Plan, also considered to be Part C, to obtain the drug coverage. However, to be enrolled in Part C you must be in Part A or Part B. 

Get Covered by Medicare Part D Today

When you are ready to enroll in the appropriate insurance coverage plan, you can work with a knowledgeable professional who can guide you. Contact us today so we can help you review which plan will work best for you.