Assistance with health care has been a growing issue in the United States for years. Many individuals, especially seniors, find that they are unable to afford medical bills or insurance for coverage. This leaves them with some tough decisions. Too often, one must choose between good health and finances. There's no middle ground. The Medicare program was developed by the government to help those who are eligible with their overwhelming health care bills.

There is a lot of information to process when considering Medicare. Knowing what Medicare is and how it works will help you choose the program that will best meet your individual needs. Use this helpful guide to get an understanding of the Medicare program and how it can benefit you.

What is Medicare?

Medicare is a government health insurance program administered by the Centers for Medicare & Medicaid Services (CMS). Medicare is the largest health insurance service in the country, with around 40 million Americans participating. To be eligible you must be a citizen of the United States and meet certain requirements. If you are not a citizen of the United States, you can contact the Social Security Administration office to learn if you would be eligible.

Can you answer yes to at least one of the following statements?

• I am 65 years of age or older.
• I am under 65, but I have certain disabilities.
• I have End-Stage Renal Disease (kidney failure that requires a transplant or dialysis).

Medicare Benefits: A Brief Summary

Medicare is basically broken down into two main categories: the "Original Medicare Plan" and the "Medicare Advantage Plan." Each category is made up of four sub-categories: Part A, Part B, Part C and Part D.

The Original Medicare Plan

The Original Medicare Plan consists of Part A. You do have the option of adding Part B and D. You will automatically be enrolled in the Original Medicare Plan unless you specifically choose to join a Medicare Advantage Plan (Part C).

The federal government manages the Original Medicare Plan. It operates on a fee-for-service plan. Most people pay a deductible and then a co-pay or co-insurance.

Medicare Advantage Plan

The Medicare Advantage Plan or Plan C combines your Part A and B coverage, but is provided by private insurance companies. You have the option of adding Part D if coverage is not already included. Medicare Advantage Plans include HMO, PPO, private fee-for-service plans, and Medicare special needs plans.

Part A Overview

Part A is hospital insurance provided by Medicare. Most people do not pay a premium for this coverage. Part A covers inpatient care in skilled nursing facilities, critical access hospitals, and hospitals. Hospice and home health care are also covered by Part A.

Go To: Medicare Part A

Part B Overview

Part B is medical insurance to pay for medically necessary services and supplies provided by Medicare. Most people will have to pay a premium to receive this coverage. Part B covers outpatient care, doctor's services, physical or occupational therapists, and additional home health care.

Go To: Medicare Part B

Part C Overview (Medicare Advantage Plan)

Part C is the combination of Part A and Part B. The main difference in Part C is that it is provided through private insurance companies approved by Medicare. With this program, you may have lower costs and receive extra benefits.

Go To: Medicare Part C

Part D Overview

Part D is stand-alone prescription drug coverage insurance. Most people do have to pay a premium for this coverage. Plans vary and cover different drugs, but all medically necessary drugs are covered. You can choose what drug plan will be best suited to your needs.

Go To: Medicare Part D

How Can I Cover Additional Expenses?

Original Medicare Plans do not cover everything. Costs that you may incur include co-insurance, co-pays, deductibles, etc. These costs are called gaps. To help cover these costs you might want to buy a Medigap policy.

Another option is Medicaid. Medicaid is a combination of federal and state programs to help cover medical costs. Eligibility depends on your income as well as the ability to meet specific requirements.

If you are new to Medicare, the first thing you need to do is decide which Medicare plan will fit your needs. Be sure to check if your current insurance works with Medicare and determine if you need help paying for additional health care costs. You will also need to schedule a "Welcome to Medicare" physical exam with a doctor. Don't forget to ask your doctor about any preventive services he might recommend. Decide if you need prescription drug coverage. Then, you should contact a Medicare representative to enroll.

Explanation of Medicare Part A

Medicare has several parts to consider when making your health care insurance choices. Understanding Medicare and how it works will allow you to choose the best plan to fit your needs. One part of the Medicare program is called Part A. Most people do not have to pay a premium for Part A because the individual or their spouse paid Medicare taxes while working. Others can buy Part A if they meet certain criteria. Below is an explanation of Medicare Part A and the coverage received under this plan. Use this information to decide if Part A is for you.

What is Part A?

Medicare Part A is a type of hospital insurance provided by Medicare. The coverage provided by Part A includes inpatient care in hospitals, nursing homes, skilled nursing facilities, and critical access hospitals. Part A does not include long-term or custodial care. If you meet specific requirements, then you may also be eligible for hospice or home health care.

Fiscal Intermediaries handle the claims for the Medicare Part A plan. These are private insurance companies that act as agents for the federal government in processing and paying Medicare claims.

What does Part A Cover?

Before learning about what Part A covers, you should also know that Medicare does not cover everything, nor does it cover the total cost for many of the covered services or medical supplies. Coverage amounts are based on which Medicare plan you have. Part A helps cover only the medically necessary services below:

Blood Transfusions

This is blood (pints) that you receive during a covered stay in a hospital, critical access hospital, or a skilled nursing facility.

Hospital Stays

Part A covers hospital stays, which includes a semi-private room, meals, general nursing, and miscellaneous hospital services and supplies. Inpatient care in critical access hospitals and mental health care (up to 190 lifetime maximum) are also covered. Hospital stays must be at least 3 days (72 hours). The time begins the first midnight after admission and does not include any hours on the discharge date.

Nursing Home or Skilled Nursing Facility

Nursing home or skilled nursing facility stays must be related to diagnosis during a hospital stay. For instance, your hospital stay was for a stroke. Then, a nursing home or skilled nursing facility stay for rehabilitation would be covered. A nursing home or skilled nursing facility stay includes a semi-private room, meals, and rehabilitative and skilled nursing services and care.

The coverage is limited to a maximum of 100 days in a benefit period. The first 20 days are paid in full, and the remaining 80 days will require a co-payment. Medicare Part A will not cover long-term care, non-skilled, daily living, or custodial activities.

Home Health Services

Home health services include limited reasonable and only medically necessary part-time care and services such as skilled nursing care, physical or occupational therapy, home health aide service, speech language pathology, and medical social services. It also includes certain home-use medical equipment (wheelchairs, hospital beds, walkers, oxygen), and other medical supplies.

Hospice Care

Hospice care is for the terminally ill who have six months or less to live. Coverage includes pain relief and symptom control drugs, medical and support services, grief counseling, and other services. Care is provided by a nearby, Medicare-approved Hospice caregiver who will visit you at your home. Medicare also provides additional care for a Hospice patient so that the usual caregiver can take a time of rest. Medicare does not cover many of the services that are provided to patients who receive Hospice assistance.

Whatever health care insurance coverage you choose, make sure you have a clear understanding of all the options, coverage and premiums. Don't be afraid to ask questions and seek a Medicare representative that can help you to fully understand and tell you what you will need to do to sign up.

Explanation of Medicare Part B

Medicare has several parts to consider when making your health care insurance choices. Understanding Medicare and how it works will allow you to choose the best plan to fit your needs. One part of the Medicare program is called Part B.

Part B Premiums

Most people have to pay a premium for Part B. You can check to see if you are qualified to receive help from your state to pay for premiums or deductibles. Otherwise, the premium is usually deducted from a Social Security, Railroad Retirement or Civil Service Retirement check. The Part B premium can also be paid every quarter or through the electronic payment option, or Medicare Easy Pay. Premiums will be based on income beginning January of 2007.

What is Part B?

Medicare Part B is a medical insurance provided by the federal government to eligible beneficiaries. The coverage provided by Part B includes medically necessary doctor's services, outpatient care, and most other services that Part A does not cover such as some physical or occupational therapies and some home health care services. Part B covers preventive services as well.

What does Part B Cover?

Medicare Part B covers many services, tests, preventive treatments, etc. that are common among health care patients, but are not covered in the Part A plan. Though many services and products are covered, keep in mind that Part B is still not a 100% insurance coverage plan. So, as with any other insurance policy, you should understand the plan and coverage completely upon enrolling. Part B helps cover only the medically necessary services listed below:

• Tests, Labs and Screenings
• Preventive services include exams, lab tests, or screening inoculations that will help prevent, manage, or diagnose a medical problem.
• Glaucoma tests are covered once per year if performed by a legally authorized eye examiner.
• Bone mass measurement is covered every two years (or as medically necessary). This is to see if you are at risk for broken bones.
• Lab Services such as blood tests or urinalysis are covered.
• Colorectal cancer screenings to find any pre-cancerous growths. Tests may include (a) annual fecal occult blood test, (b) flexible sigmoidoscopy (every four years), (c) screening colonoscopy (every ten years), or (d) barium enema (every four years).
• Diabetic screenings are covered if you have high blood pressure, dyslipidemia, obesity, or high blood sugar.
• Diabetic supplies covered include monitors, test strips, lancet devices, and therapeutic shoes.
• Diabetic self-management training is covered if prescribed by your doctor
• Cardiovascular screenings to help prevent heart attack or stroke are covered. A screening consists of testing your triglyceride, lipid, and cholesterol levels every five years.

Doctor, Hospital and Home Health Care

• Home health services include limited reasonable and only medically necessary part-time care and services such as skilled nursing care, physical or occupational therapy, home health aide service, speech language pathology, and medical social services. It also includes certain home use medical equipment such as wheelchairs, hospital beds, walkers, oxygen equipment, and other medical supplies.
• Chiropractic services will be covered if it is to correct one or more of the bones that has moved out of place in your spine subluxation).
• Ambulance services are covered if any other form of transportation would endanger your health.
• Blood (pints) that you receive during an outpatient visit or another Part B covered service.
• Clinical trials may be covered if it will help to diagnose, prevent, or treat diseases.
• Ambulatory surgery center fees are covered for approved services.
• Emergency room services for bad injuries, severe illness, or any time you believe your life is in danger
• Doctor services do not include routine physical exams except the one time "Welcome to Medicare" exam.
• Eyeglass coverage is limited to one pair of glasses and standard frames after cataract surgery.

Preventive Shots

Three hepatitis B shots are covered if you are at medium or high risk.

Additional services covered include, but are not limited to:

• Hearing and balance exams
• Mammograms
• Dialysis
• Pap tests or pelvic exams
• Mental health care
• Medical nutrition therapy
• Hospital services
• Occupational therapy
• Outpatient surgery service and supplies
• Limited prescription drugs
• Practitioner services
• Physical therapy
• Prosthetic devices
• Transplant services

Overall, Part B will provide additional coverage to help minimize your health care insurance worries. Whatever health care insurance coverage you choose, make sure you have a clear understanding of options, coverage, and premiums. Seek a Medicare representative that will take time to explain what type of coverage you will receive and will offer clear instructions for signing on with a Medicare program.

Explanation of Medicare Part C

When considering your Medicare options, it is easy to get confused and overwhelmed. Relax and take one section at a time to gain an overall understanding. Knowing what Medicare is and how it works will help you to make the best decision. One option is called Part C, or Medicare Advantage Plan (like HMO or PPO).

What is Part C?

Medicare Part C combines your Part A and Part B options and must cover all medically needed services. The difference is that private insurance companies that are approved by Medicare provide this type of coverage. In most cases, Part C is a lower-cost alternative to the Original Medicare Plan, and providers usually offer extra benefits and include prescription drug coverage (Part D).

Part C plans often have networks, and you must use the doctors or hospitals that belong to the plan. These plans help you coordinate and manage your overall care. Part C includes specialized care for people who need a large amount of health care services. If you find yourself needing medical attention while traveling out of your plan coverage area, you will still be covered for emergency or urgent care services.

What Medicare Advantage (Part C) Plans are available?

There are several plans available for Medicare Advantage. The Part C plans include the following:

*Medicare Preferred Provider Organization (PPO) - You are able to see any doctor or specialist that you choose. If they are not in your PPO network, your cost will increase. You usually can see a specialist without a referral.

*Medicare Health Maintenance Organizations (HMO) - You are able to visit doctors in the HMO network only. In most cases, you will be required to have a referral to visit a specialist.

*Medicare Private Fee-for-Service (PFFS) - You are able to see any doctor or specialist, but they must be willing to accept the PFFS's fees, terms, and conditions. You do not have to have a referral to see a specialist.

*Medicare Special Needs - These plans are designed for people with certain chronic diseases or other special health needs. These plans must include Part A, Part B, and Part D coverage.

*Medicare Medical Savings Account (MSA) - There are two parts to this plan:

(1) A high-deductible plan with which coverage won't begin until the annual deductible is met.

(2) A savings account plan where Medicare deposits money for you to use for health care costs.

Do You Need Prescription Drug Coverage?

Most Part C plans already include prescription drug coverage (Part D). If your plan offers drug coverage, you have to take it. If you have a stand-alone drug plan, and your Medicare Advantage Plan already has one, you will not be able to keep the Part C coverage. If you already have a prescription drug coverage, then you may choose a plan that does not have the drug plan included.

Eligibility for Part C

If you join Part C, you will still be in the Medicare Program and will have complete Part A and B coverage. You will continue to have Medicare rights and protection and in most cases, you will have prescription drug coverage (Part D) included as well.

You can join Part C if you reside in the service area where you wish to join, if you already have Medicare Part A and B, and if you do not have End-Stage Renal Disease (with minor exceptions).

Part C is really not that complicated once you understand it all. Before you decide to get health care insurance, it is a good idea to make sure you have a clear understanding of the coverage and premiums. This is not guesswork; don't be afraid to ask questions. A Medicare representative can help you find the answers.

Explanation of Medicare Part D

After reading about Medicare plans A, B and C, you might still be wondering where prescription drug coverage comes in, or how can you insure coverage for your medications. You'll find the answer in this next Medicare plan, or the final plan offered through Medicare, called Part D.

What is Part D (Medicare Prescription Drug Coverage)?

Part D is prescription drug coverage insurance that is provided by private companies approved by Medicare. You need to enroll when you first become eligible to keep from paying a penalty cost later. Part D was designed to help people with Medicare to lower their prescription drug costs and to protect against future costs. A prescription drug plan will also enable you to have greater access to medically necessary drugs.

How Can You Get Part D Coverage?

There are two ways to join the Medicare prescription drug coverage plan. The first is by adding it to your Original Medicare Plan or some Medicare cost plans, private fee-for-service plans, and Medical savings account plans. The second way is to join an HMO or PPO plan that includes Part D coverage. You will usually have to pay a monthly premium that will vary according to the plan you choose.

Adding Part D to the Original Medicare Plan

If you are in the Original Medicare Plan, you may add Part D coverage. Generally, you will pay a separate premium or yearly deductible.

Adding Part D to the Medicare Advantage Plan

If you are in the Medicare Advantage Plan, then chances are you already have Part D coverage. However, a few plans do not include a drug plan; therefore, you may add Part D to those plans.

How Part D Works

After you join, you will receive a membership card and materials via mail. You will pay a co-pay, co-insurance, or deductible when you use your card.

Some Part D plans have a "coverage gap." A coverage gap means when you have spent a certain amount of money, you are responsible for paying the entire cost of prescriptions while you are in the gap until you reach the out-of-pocket limit. After you meet the out-of-pocket obligation, you will only have to pay a small co-pay or co-insurance for the remainder of the calendar year.

Extra Help with Medicare Prescription Drug Costs

If you can't afford Part D costs, you may qualify for additional help. Several programs are available to assist with covering additional costs such as Medigap or Medicaid if you meet the income and resource requirements.

If you already have coverage through a previous or current employer or union, you must contact your benefits administrator before you add or change your drug coverage. Joining Part D could result in the loss of your employer or union health or prescription coverage.

A prescription drug plan can really take a lot of worry out of life. You never know what tomorrow may bring. Can you afford to risk your health? Prescription medications can cost hundreds of dollars a month, or even more in some cases. It is very important that you find a plan that will suit your budget and needs to insure that you have access to the prescription drugs you need.

Medicare Beginner Enrollment Help

Medicare can seem overwhelming when you are not familiar with the program. If you are new to Medicare and don't know where to begin, you can follow the simple steps below to help you learn how to prepare for Medicare enrollment.

Step One - Determine Eligibility

Medicare enrollment will vary according to your circumstances. The first step you need to take for Medicare enrollment is to see if you are eligible. If you can answer yes to one of the following questions then you should meet the eligibility requirements.

• Are you age 65 or older?
• Are you under 65 with certain disabilities?
• Do you have End-Stage Renal Disease (kidney failure that requires transplant or dialysis)?

If you are almost 65 years of age and do not receive Social Security Benefits, then you have the option of applying for them at the same time. You will not be automatically enrolled. You'll need to apply at the beginning of your seven-month initial enrollment period (90 days prior to your 65th birthday) to make sure your coverage start date will not be delayed.

Step Two - Gather Information

Once you have determined your Medicare eligibility, then you should gather all of your personal information on your current health care and/or prescription drug coverage. You will need to see if the coverage you have works with Medicare.

You will need to make a list of any drugs you currently use (include name of drug and dosage). Take notes on what you expect out of your insurance coverage, such as more coverage, a lower premium, etc. All the information you gather will help you to compare and select the coverage that will best meet your needs.

Step Three - Choose A Medicare Plan

Knowing what Medicare is and how it works will help you to maximize your options and make the best choices. Familiarize yourself with each Medicare Plan (Part A, Part B, Part C, and Part D). Each plan offers unique benefits that every person may need at some point in their life, so don't assume that you will not need a certain plan. Carefully consider each plan with this in mind.

Step Four - Determine If You Qualify for Additional Assistance

Unfortunately, Medicare does not cover every medical need. You may be eligible for one or more of the programs that provide additional coverage such as Medicaid, Medigap, etc. Costs that you may have to incur are co-insurance, co-pays, deductibles, or services not covered by a Medicare plan. There are several programs that you can research and apply for to help maximize your needs and reduce your health care worries.

If you get confused, don't be afraid to ask questions. Several resources are available for you to contact and get your questions answered. Once you are ready to make a decision, you can enroll in the Medicare program that best suits your needs. If or when future health needs arise, you'll be glad you took the time.

Your health care needs are important. People who can't afford to pay for medical care are given the opportunity to receive needed care through Medicaid, or medical help from your state. Programs will vary from state to state because each state sets its own rules and regulations. Medicaid is not for everybody; you will have to meet certain eligibility and income requirements to qualify.

What is Medicaid?

Medicaid is a combined federal and state program designed to pay medical costs for people with a limited income and resources. Eligibility will be determined by an evaluation of your circumstances and income.

Medicaid Eligibility Details

Federal and state laws regulate the income and eligibility requirements for the Medicaid program. To see if you qualify you will need to contact your State Medical Assistance (Medicaid) office. Some eligibility factors that will be considered include pregnancy, disability, age, blindness, income and resources, and U.S. citizenship. Your resources include bank accounts, real property, and other assets or items that can be sold for cash. Income and resource counting will vary from state to state.

If you or a family member lives in a nursing home or if you have a disabled child living at home, Medicaid has special rules for such cases. Sometimes children qualify even if the parent does not because the eligibility is based on the child's status and not that of the parents.

Is someone else's child living with you? Then that child should be eligible for Medicaid. Your income and resources do not count for that child.

Eligibility will begin three months prior to the application for those who would qualify during that period. When your circumstances change in such a way to make you non-eligible, eligibility will cease within the same month that you report the change. Failure to report increases in income or a change in status can produce negative results with future eligibility.

How Does Medicaid Work?

Medicaid typically sends a full payment directly to your health care providers. Most of the time, you won't even see a bill. Depending on your state's requirements, you may have to pay a co-payment for some medical services.

Medicaid and Medicare

Medicare doesn't cover everything. That's where Medicaid comes in for those who are eligible. Almost all of your health care costs will be covered if you have both programs. The programs are designed to help you get healthy and/or stay healthy.

What Doesn't Medicaid Cover?

• Medical assistance is not available to everyone.
• Medicaid does not provide health care services under any circumstances unless they are in a designated eligibility group.
• For a complete list of Medicaid coverage and exclusions, you will need to see you state Medicaid guide or ask your state caseworker.
• If you have a low income and meet any of the descriptions above, you should check with your local Medicaid office to see if you qualify for assistance. Don't delay in getting the health care that you or a family member is in need of. Let a caseworker evaluate your situation even if you are doubtful about your eligibility. You can also check the Web for additional information.
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A Quick Overview of HospiceWhen you or a loved one becomes a Hospice patient, the last thing you'll want to worry about is insurance coverage. The final stages of a fatal disease can devastate a family mentally, emotionally, physically, and...
A Quick Overview of Hospice

When you or a loved one becomes a Hospice patient, the last thing you'll want to worry about is insurance coverage. The final stages of a fatal disease can devastate a family mentally, emotionally, physically, and financially. Hospice care is available under Medicare Part A to help ease the burden for a family in all four of the above areas.

It is critical that a family has this coverage when a loved one reaches the final stages of cancer, kidney disease, or other similar life-threatening diseases. The patient will usually need around-the-clock care at home during this time, and Hospice workers can help relieve the family of some of the care-giving burdens as well as provide proper health care assistance that only a medical professional could provide.

What is Hospice Care?

Hospice is a Medicare program designed to provide care in a person's home for a person who has a terminal disease. A Medicare-approved Hospice will administer reasonable non-curative medical services and support for patients with a terminal illness. All services are designed to have a plan of care coordinated by the attending physician and the Hospice team.

Home and inpatient care are provided through Part A in addition to other services that are not otherwise covered by Medicare. A Hospice patient will no longer receive treatment to cure the illness. The Hospice program is designed to provide care and make the patient as comfortable and pain free as possible. The focus is to maximize the quality of life for each day the patient has remaining.

Hospice Eligibility

Not everyone is eligible for Hospice care. Certain requirements are laid out to ensure that only the patients and families who truly need Hospice services will receive them. The Hospice eligibility requirements are listed below.


• The patient must be eligible for Medicare Part A.
• A physician must certify that a person is terminally ill with a six-months or less life expectancy.
• The patient is required to sign a statement acknowledging that they want Hospice care instead of standard Medicare benefits.



How Long Can a Person Receive Hospice Care?


Hospice care receives a special benefit period. The benefit period does not have to be consecutive. You can choose care for two three-month periods followed by unlimited two-month periods. The only requirement is that the patient is certified as a Hospice patient at the beginning of each period.

Hospice care can be altered once each benefit period. Hospice care may be cancelled at any time, and the patient may return to the standard Medicare benefits; however, any days remaining in that period will be lost. If later the patient wants to return to the Hospice care program, he/she may do so during the next benefit period. The exception to this is if the patient keeps the Medicare Part B plan. Part B may in this case be used for other services as long as they do not relate to the terminal illness.

What Does the Medicare Hospice Program Cover?

The Hospice program covered by Medicare includes physician services, intermittent 24-hour, on-call nursing care, any illness related medical appliances or supplies, and pain and symptom management outpatient drugs. The program also includes acute short-term and respite care, homemaker and home health aide services. Other services provided are physical and occupational therapy, speech-language pathology, medical social services, and counseling. Any and all services related to the treatment of the terminal illness have to be covered as well.

What the Medicare Hospice Program Does NOT Cover

There are some limitations to Hospice coverage. The treatments Medicare will not pay for include any treatment that is not for pain or symptom management. It also will not pay if the patient has an additional health care provider that covers the same services that Hospice provides.

What Are the Patient's Out-of-Pocket Expenses?

Your Medicare plan will pay the Hospice expenses. Costs will vary depending upon the care required. The patient will be responsible for the following:

• Biologicals or Drugs - 5% of prescription cost with a $5.00 maximum.
• Respite Care (inpatient)- 5% and may vary slightly with a five-day maximum stay.

Since the start of Hospice services many years ago, families all over the United States have benefited tremendously from the program. It's well worth looking into if you or a family member has been diagnosed with a terminal illness. It's good to understand your eligibility status and how Hospice works beforehand so you will be prepared if tragedy strikes your family.

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A Quick Medigap OverviewWhen you have the Original Medicare Plan coverage, you will find it does not provide 100% coverage. You will be required to pay deductibles, co-pays, and co-insurance. While Medicare pays for a lot of health care services,...
A Quick Medigap Overview

When you have the Original Medicare Plan coverage, you will find it does not provide 100% coverage. You will be required to pay deductibles, co-pays, and co-insurance. While Medicare pays for a lot of health care services, there are still many it does not cover. Medigap was designed to help pay the costs that Medicare does not cover.

What is Medigap?

Medigap is health care insurance provided by private insurance companies to cover the gaps in the Original Medicare Plan. Both plans will pay their shares of health care costs to your health care provider. Medigap policies must have specific benefits, and insurance companies are only allowed to sell standardized Medigap policies.

Medigap Eligibility Requirements

Medigap coverage only works in conjunction with the Original Medicare Plan. Typically, you must have Medicare Part A and Part B. If you and your spouse want Medigap coverage, you must each purchase separate policies. Medigap policies will only cover one person per policy.

If you enroll in a Medicare Advantage Plan, your Medigap coverage will not work. You may wish to (although legally you don't have to) cancel your Medigap policy if you choose a plan aside from the Original Medicare Plan.

Available Medigap Plans

Federal and state laws regulate Medigap policies. These laws are put in place to protect you as a beneficiary. Medigap policies have to be clearly labeled as "Medicare Supplement Insurance." In some states, you may be able to choose from up to 12 different standardized policies (Medigap Plans A through L).

Each plan offers a different set of basic and additional benefits and is the same for every insurance company. Because benefits are the same for every insurance company, you do not want to overpay. Insurance companies set their own prices and decide which policies they want to sell.

Medigap policies no longer cover prescription drugs. If you have a Medicare Prescription Drug Plan (Part D) and a Medigap policy that covers drugs, then you need to tell your Medigap insurance provider to remove the drug coverage from your policy. You may choose to keep the Medigap policy with prescription drug coverage; however, you cannot have both. Medigap drug coverage is not as beneficial as Part D coverage.

Plans A through J

Plans A through J have more benefits, higher premiums, and lower out-of-pocket expenses. Basic benefits include Medicare Part A and B co-pay or co-insurance, and three pints of blood. Extra benefits may include Skilled Nursing Facility co-insurance, Medicare Part A and B deductibles, Medicare Part B excess charges, foreign travel emergency services, at-home recovery, preventive care, and some may still cover prescription drugs.

Plans K through L

Plans K through L have lower premiums and higher out-of-pocket expenses. Basic benefits include Medicare Part A hospital benefits, Medical Part A and B co-insurance or co-pay, blood, and hospice care. Extra benefits include Skilled Nursing Facility co-insurance and Medicare Part A deductibles.

Remember, when choosing a Medigap plan, compare each plan and then compare different insurer quotes. You want to make sure you have adequate coverage to meet your needs, but you don't want to pay more when each plan is the same for every insurance company.

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A Quick Overview of the AARP Medicare Rx PlanAARP is a Medicare approved organization you can trust. It offers three different drug plans for you to choose from. AARP designed these drug plans to provide prescription drugs to Medicare beneficiaries...


A Quick Overview of the AARP Medicare Rx Plan

AARP is a Medicare approved organization you can trust. It offers three different drug plans for you to choose from. AARP designed these drug plans to provide prescription drugs to Medicare beneficiaries at lower costs. You can't afford not to enroll if you are eligible. When the need arises for prescription drugs, you'll have peace of mind knowing that a majority of your medication costs will be covered. Read below to learn more about this popular program.

What Can I Expect from an AARP Medicare Rx Plan?

When choosing an AARP Medicare Rx Plan, you can expect affordable and flat co-pays and three plan options (two have no annual deductibles). Drug coverage will include every brand name prescription drug or its generic brand that is covered by Medicare Part D with over 60,000 participating pharmacies.

What Medicare Rx Plans Does AARP Offer?

Three prescription drug plans will be offered in 2007. They are AARP Medicare Rx Plan, AARP Medicare Rx Plan - Enhanced, and AARP Medicare Rx Plan - Saver. Each plan may have one or more of the four tiers (co-pay/co-insurance coverage levels) offered for you to choose from.

Description of Tiers and Co-Pay

• Tier 1 - This has the lowest co-pay and includes most generic drugs.
• Tier 2 - This has the medium co-pay and includes preferred brand name drugs.
• Tier 3 - This has higher co-pay and includes non-preferred drugs.
• Specialty Tier - This is the highest cost co-insurance.

Each of the three plan options is unique. Listed below are the items covered by each plan.

AARP Medicare Rx Plan

• Includes 100% of the drugs covered by Medicare Part D
• Mid-priced premium
• Flat and simple co-pays
• No deductible
• Over 60,000 participating network pharmacies
AARP Medicare Rx Plan - Enhanced
• Includes 100% of the drugs covered by Medicare Part D
• Tier 1 generic drug coverage (w/in coverage gap)
• Bonus drug list (drugs not covered by Medicare Part D)
• Flat and simple co-pays
• No deductible
• Over 60,000 participating network pharmacies
AARP Medicare Rx Plan - Saver
• Low monthly premiums
• Low co-pays
• Annual deductible ($265)
• Includes 100% of the drugs covered by Medicare Part D

How Difficult Is It to Fill a Prescription?

With over 60,000 participating network pharmacies, you should be able to get a prescription filled just about anywhere you go. You also have the convenience of ordering your prescriptions by mail. By using the mail service, you will save on prescription costs, have free shipping, and avoid long lines or waiting times.

AARP Medicare Rx Plan Enrollment Information

Open enrollment is between November 15th and December 31st of each year.
You will need to compare plans to see which will meet your individual needs. If you are currently an AARP Medicare Plan beneficiary, your membership will be renewed automatically; however, you may use the open enrollment period to make any needed changes to your plan.

How Do I Prepare for Enrollment?

First, you need to check to see if you qualify for financial assistance. Based on your income and resources, you may be eligible for assistance to help offset or completely pay additional out-of pocket expenses (costs not covered by your insurance plan). Pre-planning is important, and it may take up to eight weeks for financial assistance to be processed and approved. Don't delay. You don't want to miss the enrollment period (Nov 15 - Dec 31).

Next, you will need to gather all your information on health care or drug coverage you may have. You will also need to make a complete list of the names, dosage, and refill information for any prescription drugs you currently take. This information will help you to compare plans and make the best choice.

The final step is to compare several Medicare Part D Plans in your area. There are several things you should consider in order to accurately compare plans. You will need to find out what the monthly premiums are, and if there is a deductible. Also, ask the following questions: What is the company's reputation? What drugs are covered? Is there a co-pay amount?

Once you have completed these steps, it is time to select the option that will provide you with the coverage you require, and enroll in the plan you have chosen. With the costs of prescription drugs on the rise, this program can help you get the medications you need when you need them.

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Stop Medicare Fraud Before You Become a VictimEvery year, millions of dollars are taken from the Medicare program through deceptive practices. Medicare fraud hurts not only the program as a whole, but everyone who receives Medicare benefits. The quick guide...
Stop Medicare Fraud Before You Become a Victim

Every year, millions of dollars are taken from the Medicare program through deceptive practices. Medicare fraud hurts not only the program as a whole, but everyone who receives Medicare benefits. The quick guide below reveals how Medicare fraud takes place, why it affects you as an end beneficiary, and what you can do to help prevent it.

What is Medicare Fraud?

Medicare fraud occurs when false claims are made on behalf of a real beneficiary. For example, you visit a particular physician or medical clinic. They ask for your Medicare card and give you a certain amount that is due, but then bill Medicare for more than that amount. They pocket the difference. Another type of Medicare fraud is when someone bills Medicare for services or equipment that you never received or for items different from what you received.

A dishonest individual might also use the Medicare card of another to receive medical services or to buy equipment. Or, someone may return home medical equipment, but continue to bill Medicare for the equipment.

There are other variations of Medicare fraud, but these are the most common.

Why Should You Care?

You may ask, "Why should I care if someone else commits Medicare fraud?" There are two main reasons you should join the battle against Medicare fraud. One, your Medicare co-pay costs will increase little by little because of money lost through fraud. Just as a retail store might increase prices to cover the losses of theft, Medicare costs will increase for everyone when fraud occurs.

Two, you or your loved one could be the next victim. If you frequent the emergency room, pharmacy, or doctor's office, then you are susceptible to becoming a victim of Medicare fraud. Someone may steal your Medicare card, or you might encounter a dishonest person working at a doctor's office or pharmacy. Either way, the burden of proof will fall upon you because the Medicare card and billing information will be in your name.

Detecting Medicare Fraud

Detecting Medicare fraud is easy if you keep an eye out for suspicious activities. Beware of providers that offer services for "free" when you have already given them your Medicare card. Also, if a provider offers to waive your co-payments on services routinely without checking to see if your financial situation has improved, you should be leery of this practice.

Other "red flags" to watch for include pressure selling for higher-priced services, receiving Medicare bills for services you have not received, so-called "free" consultations for Medicare patients, marketing tactics being used by a provider such as telemarketing, and charges for co-payments on services that are supposed to be covered 100 percent by Medicare.

Do Not Falsely Accuse

If you suspect that a provider has committed Medicare fraud, double check with the provider to be sure it is not a simple mistake first. Sometimes human and computer errors do occur, so give your provider the benefit of the doubt from the start. If so-called "errors" seem to be happening often, then it's time to investigate! The last thing you want is to wrongly accuse your health provider, so be sure to approach suspected Medicare fraud with caution.

Before Reporting a Provider

Before you report a provider for Medicare fraud, be sure you have all the facts. You'll need all vital information about the provider including name, phone number, address, type of practice, etc. Also, you'll need to gather all the facts about the incident so you can clearly present your case. Write or type a detailed timeline of events, the item(s) or service(s) that were billed incorrectly, the date when this occurred, and any other pertinent information.

Take Preventative Measures

If you encounter a situation where you believe you or a loved one have fallen victim to Medicare fraud, report it to your local and state Medicare representatives. Also, take the following steps to help prevent this from happening to you:

1. Never give anyone your Medicare card or claim number who is not your caregiver or physician.

2. Beware of those who wish to review your medical records when they are not providing medical services to you.

3. Beware of "free" consultations and Medicare services being offered by a clinic or physician.

4. Never request medical services that you do not actually need.

5. Beware of providers that offer to get Medicare to pay for services or items
that are usually not covered by Medicare.

Most of all follow your instincts. If a situation doesn't seem right, investigate to find the answers. You or your loved one can be safe from Medicare fraud if you use precaution during every medical situation. Keep in mind that criminals do not always come in dark clothing with masks on their faces. Those who commit Medicare fraud can appear to be normal caregivers or physicians, so keep your guard up any time you give out personal information such as your Medicare card.

Use this knowledge to join the fight against Medicare fraud, and help America to stay healthy!

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Medicare Consumer Guide was created by a small group of Americans, just like you, who were having a hard time understanding the Medicare Health Care plan. This site combines all of our personal research and efforts into a single,...
Medicare Consumer Guide was created by a small group of Americans, just like you, who were having a hard time understanding the Medicare Health Care plan. This site combines all of our personal research and efforts into a single, easy to use guide. If you thought the information on our site was helpful, pass it along to others. If you have questions, just email us below.


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