Medicare

Medicare Monday participants receive information on the changes, updates and requirements for Medicare Parts A, B, C and D. Information on selecting and changing Medicare Advantage, Medicare Supplements and Prescription Drug Plans was available. In addition, information was presented on Extra Help or Low Income Subsidy for low income persons needing assistance to pay for prescription drugs and various discount products as well.

What are Medicare Advantage Plans?
Though it is a different 'part' of Medicare, Part C or Medicare Advantage is a method for beneficiaries to receive their standard Medicare benefits (Parts A and B) through a private carrier, possibly with additional benefits and/or costs. The federal government pays each Advantage plan a monthly amount to provide the same care as Original Medicare. Medicare Advantage plans may offer additional benefits as well.

There are seven types of Medicare Advantage Plans available in Colorado. Each operates differently in terms of networks, coverage and cost.

The Medicare Savings Programs consist of of three programs that will at a minimum pay the $104.90 (2013) monthly Medicare Part B premium for eligible seniors; it will also pay the higher premium for other reasons such as late enrollment. For those with lower incomes, coverage may also include Medicare Part A and B deductibles, co-payments and co-insurance. Individuals are also automatically enrolled in the Medicare Part D Extra Help (also known as the Low Income Subsidy) which provides assistance with prescription costs. For more information on Extra Help, including required support documentation, please click here.
Listed below are the programs. If you qualify for any of the programs, you can apply by completing the Colorado Medicaid application and checking the box for 'Medicare Savings Program'.

What is Medicare? Who qualifies?
Medicare is the government financed health insurance program for seniors and others receiving Social Security benefits. All persons aged 65 and over are eligible for Social Security benefits, and disabled persons who have received Social Security for 24 months are eligible for Medicare. Individuals who have Lou Gehrig's disease can receive Medicare immediately upon approval of Social Security Disability Insurance (SSDI).

How does Medicare work?
Medicare has four parts that cover different health care aspects.
Part A pays for hospital stays and other related services like home care, and is free to individuals entitled to Social Security (individuals not entitled to Social Security can purchase Part A coverage for $441 per month in 2013). The deductible for 2013 is $1,184 per 60-day benefit period.

What do we mean by 'Original' Medicare?
Medicare Parts A and B, together often colloquially known as Original Medicare or Straight Medicare, are the direct government insurance most people think of when they think of Medicare. Together they provide hospitalization and medical services coverage, including doctor's visits, screenings, emergency room care, surgery, medical supplies and equipment, home care, skilled nursing care, hospital inpatient costs and hospice care.

Who is eligible and how much does it cost?
For Parts A and B, anyone 65 and older who is entitled to Social Security is eligible (those who are disabled and have been on Social Security for 24 months are also eligible). Those not eligible for Part A (meaning those individuals or spouses who have not paid into Social Security for at least 40 quarters) can buy-in to Part A (in 2013) for $243 a month (for those with 30-39 quarters) or $441 a month for all others in.

The Medicare Advantage Work Group is a bimonthly meeting that includes representatives of the insurance industry, state and federal government and consumer advocates who come together on a regular basis to discuss updates to Medicare policy, industry concerns and consumer issues.

The meeting is open to the public and RSVP's are requested.

Please click on a link below to check the location and date of a particular meeting.

Low income Medicare beneficiaries will have more opportunities in 2010 to receive assistance with prescription drug costs as well as payment for the Medicare Part B payments. This can total more than $1150 per year in savings. Hundreds more people will benefit from the changes in the amounts of the resources limits and elimination of life insurance policies as a resource to qualify for extra help to pay for prescription drug costs.

Low income Medicare beneficiaries will have more opportunities in 2010 to receive assistance with prescription drug costs as well as payment for the Medicare Part B payments. This can total more than $1150 per year in savings. Hundreds more people will benefit from the changes in the amounts of the resources limits and elimination of life insurance policies as a resource to qualify for extra help to pay for prescription drug costs.

What is Part D?
Part D is how Medicare provides prescription drug coverage to Medicare beneficiaries. Coverage is provided solely through private insurance carriers, and is available as a stand-alone prescription drug plan (PDP) or as part of a Medicare Advantage Plan.

Coverage is available for generic and name-brand drugs under a formulary. Plans are not allowed to discontinue coverage of a drug during the course of treatment. Plans must cover at least two drugs in each drug class, except for anorexia, facial hair, weight gain or loss, fertility, cosmetic drugs, cold medicine, vitamins and minerals, over the counter drugs, barbiturates or benzodiazepines. Plans must cover most or all drugs for antidepressants, anticonvulsants, antipscyhotics, antiretrovirals, anticancer and immunosuppressants.

Medicare Supplemental Insurance policies (also known as Medigap policies) are sold by private insurance carriers in order to complement Original Medicare or Medicare Advantage and offer coverage for other treatments and services not approved by Medicare. These policies are regulated by federal and state governments, and must be offered in standardized form. Eleven plans can be offered, but all carriers must offer at least the standard benefit Plan A.

The benefits are standardized so as to be comparable between Plans A, B, C, D, F, F+ (High Deductible), G, K, L, M and N. Plan A or the basic supplemental insurance policy must:

• Be guaranteed renewable (except for non-payment of premiums)
• Provide co-insurance for hospitalization for days 61-100 (prior to that there is no co-insurance
• Provide a lifetime reserve benefit of 365 days of hospitalization coverage in excess of 150 days.