Medicare is health insurance for people:
- 65 and older OR
- That are found disabled by the disability determination board (2 years after disability begins) OR
- People with End Stage Renal Disease (ESRD) - permanent kidney disease that requires dialysis or a renal transplant (begins the month that a home training dialysis program begins or after the third month of center dialysis treatments).
Medicare Alphabet Explained:
- Medicare A: Hospital Insurance (inpatient hospital care, not including physician fees)
- Medicare B: Medical Insurance (physician services both inpatient and outpatient, clinic visits, certain home health services, DME)
- Medicare C: Medicare Advantage (formerly Medicare + Choice)
- Medicare Managed Care Plans
- Medicare Preferred Provider Organization Plans (PPO)
- Medicare Private Fee-for-Service Plans
- Medicare Specialty Plans
- Medicare D: Prescription Drug Coverage (excluded drugs include barbiturates, benzodiazepines, and OTC medications; though patients that are "dual eligible" can still get these specific classes of medications through Medical Assistance).
Medigap plans are Medicare supplement policies
- The Wisconsin Medigap Helpline
- Search for Medigap Policies
Delaying Medicare Part B: If clients do not take Part B when they were first eligible for Medicare, they may sign up only during the General Enrollment Period (with the exception of people who qualify for the Special Enrollment Period). The General Enrollment Period runs from January 1 through March 31 of each year. Coverage is then effective the next July 1st. The cost of their Part B may go up 10% for each 12-month period that they could have had Part B but did not take it, and they will have to pay this extra amount as long as they have Part B, except in special cases.
Delaying Medicare Part D: If clients do not take Part D when they were first eligible, they may only sign up during the “annual coordination election period”, which is November 15th to December 31st of each year. If they did not have “creditable coverage” (coverage at least as good as Medicare D) via another insurance plan, they will incur a 1% penalty per month that they didn’t sign up.
Medicare D Low Income Subsidy: One option for those struggling with drug costs is to have a Low Income Subsidy applied to their existing prescription account. Depending on a variety of factors (not the least of which is actual income) a member of an existing plan may have their premium paid for all or in part and will have a reduced copay for their medication. To request a review for subsidy contact the Social Security Administration at (800) 772-1213.
|Level||Deductible||Generic Copay||Brand Copay||Specialty Copay||Catastrophic Coverage|
|1||0||2.15||5.35||15%||$0 copays on all meds|
|2||0||1.00||3.10||15%||$0 copays on all meds|
|4||$53 max||15%||15%||15%||2.15 Generic & $5.35 Brand copays|
ADVANTAGE PLANS (HMO)
- 1-800-242-1060 (Board of Aging and Long Term Care Hotline)
- (608) 266-3585
- State of WI Office of the Commissioner on Insurance
Affordable Care Act
CMS Regional Offices
HSA and Medicare
- You can continue to use the money already in Health Savings Accounts for uninsured medical expenses, but you can no longer make new contributions to your health savings account after you sign up for Medicare.
Medicare B Premium Cost
Medicare Caregiver Information
Medicare D Costs
MEDICARE D AND EGHP
- Do NOT sign up for a Medicare D plan if you have an EGHP as you could lose your EGHP coverage!
Medicare D Extra Help
Medicare and The Health Care Exchange
Medicare Supplier Directory
Medigap (Medicare Supplemental) Insurance
- Medigap insurance companies can impose a waiting period of up to six months before covering a pre-existing condition.
- Exception 1: applicants have 6 months from date they are eligible for Medicare to take a Medicare Supplement without a pre-existing condition penalty.
- Exception 2: the pre-existing condition waiting period can be shortened, waived, or eliminated if the individual has had at least six months of prior, continuous health coverage before applying for a Medigap policy during initial enrollment.
- Medigap plans are NOT being affected by the Affordable Care Act
Same Sex Marriage and Medicare
Tricare and Medicare
Who Pays First?