How Medicare Works

Medicare has two parts:

1.  Part A (Hospital Insurance)

2.  Part B (Medical Insurance)

Part A helps pay for:

• Inpatient Hospital Care
• Some Skilled Nursing Care
• Hospice Care
• Some Home Health Care

How to Get Part A

Most people get Medicare Part A automatically when they turn age 65. They do not have to pay a
monthly premium for Part A because they or a spouse paid Medicare taxes while working.

If you are your spouse did not pay Medicare Taxes while working, you may still be able to buy Part A but you may have to pay for it.

Part B helps pay for:

Doctors' Services,

Outpatient Hospital Care, and

Some other medical services that Part A does not cover (like some home health care).

You pay the Medicare Part B premium of $55.00 per month in 2004. Rates can change every year.
Also, this rate may be higher if you did not choose Part B when you first became eligible at age
65. In this case, the cost of Part B will go up 10% for each 12-month period that you could have had
Part B but did not sign up for it (except in special cases). You will have to pay this extra amount for
the rest of your life.

How to Get Part B

You are automatically eligible for Part B if:

You are eligible for premium-free Part A,

You are a US citizen or permanent resident age 65 or older

If you choose to take Part B, Medicare takes the monthly premium out of your Social Security,
Railroad Retirement, or Civil Service Retirement payment. If you don't receive any of these
benefits, you will get a bill for the Part B premium every 3 months.

If you did not choose Part B when you were first eligible, you can sign up during 2 enrollment periods:

1.  The General Enrollment Period (Jan 1 - Mar 1 each year and starts July 1 of that year)

2.  The Special Enrollment Period (within 8 months of termination of group or union health plan)

What Is A Medigap Policy?

A Medigap policy (Medicare Supplement) is a health insurance policy sold by private insurance
companies to fill the "gaps" in Original Medicare Plan Coverage. There are 10 standardized Medigap
 plans called "A" through "J". Each plan A-J offers a different set of standardized benefits. Plan A
offers the least benefits and Plan J offers the most benefits.

When you buy a Medigap Policy, you pay a premium to the insurance company. As long as you pay the premium, a policy purchased after 1990 is automatically renewed each year.

Why Do I Need A Medigap Policy?

If you are on the Original Medicare Plan, a Medigap Policy may help you:

Lower your out-of-pocket costs.

Get more health insurance coverage.

You may want to buy a Medigap Policy because Medicare does not pay for all of your health care. There are "gaps" or costs that you must pay in the Medicare Plan.  The chart below illustrates this.  This chart shows what Medicare does not cover and then tells you what each of the standardized plans cover. 

Click here for pricing information.

	Medicare Supplement Plan Covers
Medicare Does Not Cover	A	B	C	D	E	F	G	H	I	J
Part A - Hospitalization
$912 initial hospital deductible each benefit period.
$228 co-payment for days 61-90 in a hospital.
$456 a day co-payment for days 91-150 in a hospital.
100% of Medicare allowable expenses for additional 365 days after Medicare benefits stop completely.
Calendar year blood deductible (first 3 pints of blood).
$114..00 per day for days 21-100 in a Skilled Nursing Facility.
Part B - Physician Care & Medical Services
$100 Part B deductible.
20% of Medicare-approved amount (Part B co-insurance)
100% of the difference between the actual Medicare Part B charge as billed (not to exceed any charge limitation established by the Medicare program or state law) and the Medicare approved Part B charge.
Additional Benefits Not Covered By Medicare
At home recovery benefits up to $1,600 per calendar year.
Benefits for medically necessary care received in a foreign country, after a $250 deductible.
Up to $120 annually for a routine physical exam and tests.
Basic Drug Benefit
Plans offered by companies we currently represent	A	B	C	D	E	F	G	H	I	J
Click here plan information, and rates...