-Enrollment January 1 to March 31 to enroll in Part B
-Coverage will start July 1 of that year.
20% of the Medicare-approved amount for durable medical equipment.
-You may need to pay a co-payment of no more than $5 for each prescription drug and other similar products form pain relief and symptom control while you are at home.
-In rare case it is not covered, Medicare Drug Plan could see if it is covered under Part D.
-You may need to pay 5% of the Medicare-Approved amount for inpatient respite care.
-Medicare doesn’t cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).
-Days 1 -60 $0 coinsurance for each benefit period.
-Days 61 -90 $315 coinsurance per day of each benefit period.
-Days 91 and beyond $630 coinsurance per each “lifetime reserve day.”
-After day 90 for each benefit period (up to 60 days over your lifetime).
-Beyond lifetime reserve days all costs.
-Days 1-60 $0 coinsurance per day of each benefit period.
-Days 61-90 $315 per each day (up to 60 days over lifetime.)
-Days 91 and beyond $630 coinsurance per “lifetime reserve day”. After day 90 for each benefit period (up to 60 days over your lifetime).
-Beyond lifetime reserve days: all costs.
-20% of the Medicare-approved amount for mental health services you get from doctors and other providers while you are a hospital in-patient.
-*There’s NO limit to the number of benefit periods you can have when you get mental healthy care in general hospital. You can also have multiple benefit when you get care in a psychiatric hospital.
-*Lifetime limit to 90 days*
-Days 21-100 = $157.50 coinsurance per day of each benefit period.
-Days 101 and beyond = all costs.
-Most people pay the Part B premium $104.90 each month if you sign up when you are first eligible.
However, if your modified adjusted gross income is reported on your IRS TAX RETURN from 2 years ago, is above a certain amount, you may pay more.
-20% of the Medicare-Approved amount for durable equipment.
20% of the Medicare-Approved
20% of the Medicare-Approved amount for visits to a doctor or other health care provider to diagnose or treat your condition. The Part B deductible applies.
-If you get your services in a hospital, outpatient clinic or hospital outpatient department, you may have to pay an additional copayment or coinsurance amount to the hospital. This amount will vary depending on the service provided, but will be between 20-40% of the Medicare-Approved amount.
-You also pay coinsurance for each day of partial hospitalization services provided in a hospital outpatient setting or community mental health center, and the Part B deductible applies.
-For all other services, you also generally pay a copayment for each service you get in an outpatient hospital setting. You may pay more for services you get in a hospital outpatient setting than you would pay for the same care in a doctor’s office.
-For some screenings and preventative services, coinsurance, copayments, and the Part B deductible, don’t apply. (so you pay nothing).
-The Part C monthly premium varies by plan.
-Deductibles, copayments & coinsurance, they also vary by plan.
-The Part D monthly premium varies by plan (Higher income consumers may pay more).
-Late Enrollment Penalty = The cost of the late enrollment penalty depends on how long you went without Part D or creditable prescription drug coverage.
-You may owe a late enrollment penalty if you go without Part D or creditable prescription drug coverage for any continuous period of 63 days or m ore after your initial enrollment period is over.
-In general, you’ll have to pay this penalty for as long as you have a Medicare Drug Plan.
-Deductibles , copayments, & coinsurance. The amo9unt you pay for Part D deductibles, copayments, and or coinsurance varies by plan.
-Skilled Nursing Facility Care
-Nursing Home Care (as long as custodial care you need).
-Home Health Services
1. Federal and State Laws
2. National coverage decisions made by Medicare about whether something is covered.
3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should in their area.
-Medicare Part B covers 2 types of services:
1. Medically necessary services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
2. Preventive Services = Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
*You pay nothing for most services if you get the services from a health care provider who accepts assignment.
-Medicare Part B covers things like:
*Durable Medical Equipment (DME)
_Getting a second opinion before surgery.
-Limited outpatient prescription drugs.
1. Talk to your doctor or health care provider about why you need certain services.
2. Ask if Medicare will cover those services.
-Many drug plans place drugs into different ‘tiers” on their formularies.
-Drugs in each tier have a different cost.
-A drug in a lower tier will cost you less than a drug in a higher tier.
-If your drug is in a higher tier and your prescriber thinks you need that drug instead of a similar drug or a lower tier, you or your prescriber can ask your plan for an exception to get a lower copayment.
1. Medicare Prescription Drug Plan (Part D)
*Sometimes called (PDP), add coverage to Original Medicare. Some Medicare private fee-for-service (PFFS) plans. Medicare Medical Savings Accounts (MSA) plans.
2. Medicare Advantage Plan (Part C)
*Like an HMO or PPO or other Medicare Health Plan that offers Medicare prescription drug coverage, you get all of your Medicare Part A, Part B and prescription drug Part D through these Plans.
Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PD’s” .
*You must have PART A and PART B to join Medicare Advantage Plan.
-The “primary payer” pays what it owes on your bills first and then sends the rest to the “secondary payer”.
-In some cases, there may also be a “third payer”.
-The one that pays second is the “Secondary Payer” and only pays if there are costs the primary insurer didn’t cover.
-The secondary payer (which may be Medicare) may NOT pay all of the uncovered costs.
_If your employer insurances is the secondary payer, you may need to enroll in Medicare Part B, before your insurance will pay.
-If the insurance company doesn’t pay the claim promptly (usually within 120 days), your doctor or other provider may bill Medicare. Medicare may make a conditional payment to pay the bill, and then, later recover any payments the primary should have made.
-If Medicare makes a conditional payment for an item or service and you get a settlement, judgment, award or other payment for that item or service from an insurance company later, the conditional payment must be repaid to Medicare.
-You are responsible for making sure Medicare gets repaid for those conditional payments.
-Medicare recovers a conditional payment, by you or your representative calling the Benefits Coordination & Recovery Center (BCRC).
*The BCRC gathers information about any conditional payments, Medicare made related to your pending settlement, judgment, award or other payment.
*The BCRC gets the final repayment amount, on your case and issues a letter requesting repayment.
-If you have Medicare Advantage Plan you can apply for a Medigap policy, make sure you can leave the MAP before your policy begins.
-You pay the private insurance company a monthly premium for your Medigap policy in addition to the monthly Part B premium that you pay to Medicare.
-A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you will each have to buy separate policies.
-You can buy Medigap policy from any insurance company that is licensed in your state to sell one.
-Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company cant cancel your Medigap policy as long as you pay the premium.
-Some Medigap policies sold in the past cover prescription drugs, but Medigap policies sold after Jan. 1, 2006 aren’t allowed to include prescription drug coverage. You have to join Part D to get prescription drug coverage.
-It is illegal for anyone to sell you a Medigap policy if you have a Medicare Medical Savings Account Plan (MSA).
-Medicare Prescription Drug Plans
-Employer or union plans, including Federal Employers Health
-Long Term Care insurance policies
-Indian Health Service, Tribal and Urban Indian Health Plans
-You choose a doctor from our broad network of physicians to coordinate your care. These plans have affordable, fixed costs, and offer all the benefits of Original Medicare, plus some added features.
$0 coverage for most annual screenings.
-Choice of a primary care physician in the plan network.
-More predictable out-of-pocket costs that make it easier to budget.
-You and your doctor coordinate all of your care.
-Emergency coverage when you travel outside the united states.
-Prescription drug coverage (some plans do not include drug coverage).
-Referral-free visits to any doctor nationwide.
-Choose any doctor or hospital (with most plans).
-Affordable monthly plan premiums for most plans.
-Prescription drug coverage equal to or better than the standard requirement for a Medicare Part D plan.
-Emergency coverage anywhere in the world.
-$0 coverage for most annual screenings.
-Your out-of-pocket costs are lower when you choose a provider from Humana’s list of in-network-providers.
-Affordable monthly plan premium
40 coverage for most annual screenings.
-Humana Gold Choice is a Medicare Advantage Private Fee for service (PFFS) plan.
-Prescription drug coverage equal to or better than the standard requirements for a Medicare Part D plan.
-Emergency coverage when you travel outside the U.S.
-Special Needs plans provide personalized guidance and resources that help members get the right care and information.
-Unlike other Medicare Advantage plans, Special Needs plans are only available to people with specific conditions who qualify.
-Many of Humana Special Needs plans have a $0 or low monthly premium. Depending on the specific plan, benefits may also include routine dental, vision, hearing, non emergency, transportation, fitness membership, over the counter items and more.
Plans for individuals with one or more of the following conditions: diabetes mellitus, cardiovascular disorders, chronic heart failure, chronic lung disorders
-Humana’s Chronic Condition Special Needs
Offer specialized care by tailoring benefits to help meet the needs of people with conditions like yours and by offering provider choices and drug formularies.
-Dual Eligible Special Needs
For individuals who are entitled to Medicare and who are eligible for some level of assistance from the State Medicaid Program.
New York, North Carolina, Ohio, Puerto Rico, Tennessee, Texas, Virginia and Washington
This is when you can join a Medicare Advantage Plan. You can enroll in Medicare Supplement Plans, however, at anytime if you meet the eligibility requirements.
2. ARRIVAL ON THE FLOOR
3. DATE OF DISCHARGE
You have the right to appeal if Medicare, your Medicare health plan, or your Medicare drug plan denies one of these:
A request for a health care service, supply, item, or prescription drug that you think you should be able to get
A request for payment of a health care service, supply, item, or prescription drug you already got
A request to change the amount you must pay for a health care service, supply, item, or prescription drug
You can also appeal if Medicare or your plan stops providing or paying for all or part of a health care service, supply, item, or prescription drug you think you still need.
Whether a particular drug is covered
Whether you have met all the requirements for getting a requested drug
How much you’re required to pay for a drug
Whether to make an exception to a plan rule when you request it
The drug plan must give you a prompt decision (72 hours for standard requests, 24 hours for expedited requests). If you disagree with the plan’s coverage determination, the next step is an appeal.
You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury, or
Leaving your home isn’t recommended because of your condition, and you’re normally unable to leave your home because it’s a major effort
You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.
adult care facilities. They work to resolve problems of individual residents and to bring about changes at the local, state, and national
levels that will improve residents’ care and quality of life. They may be able to provide information about home health agencies in your area.
In most states, you can enroll children who are between 2 weeks old and 25 years old in a HumanaOne health benefits plan. Qualifications for eligible dependents may vary for Short-Term Medical plans.
Humana One offers a wide range of health plans for individuals and their families. Benefits of these plans may include coverage for inpatient and outpatient hospital services, preventive care treatment by specialists, and prescription drugs.