SHIP
State Health Insurance & Assistance Program
Medicare 101
November 2008
Medicare is the federal health insurance program available to beneficiaries who are 65 years and older (also for adults with disabilities of any age). To be eligible, you must have at least (10) years of full-time employment on your record
Traditional Medicare offers beneficiaries (4) PARTS:
Part A, Part B, Part C, and Part D
Medicare Part A - Helps cover your inpatient care in hospitals, skilled nursing facilities, but not custodial or long term care. It also helps cover hospice care and some health care.
- Cost: Most people don’t have to pay a monthly premium for Part A; most beneficiaries pay Medicare taxes during their lifelong employment.
Medicare Part B - Medicare Part B helps cover outpatient medical services /outpatient care. Part B also covers some preventive services like exams, lab tests and screening shots. Part B is optional; a beneficiary can refuse Part B without penalty, if they have creditable coverage thru an employer and are currently employed
- Cost: Most beneficiaries will pay the standard premium of $96.40/month and standard deductible of $135/yr in 2009. For some beneficiaries, there is financial assistance available through the Medicare Savings Program (SLMB, QMB OR QI1). These programs are administered through the State of Montana/Medicaid or the local Office of Public Assistance. If a beneficiary does not enroll in Part B when they are eligible and/or do not have creditable coverage, they are penalized 10% per year when they do enroll.
Medicare Part C – Medicare Health Plans - also known as Medicare Advantage Plans. Medicare Advantage Plans are health plan options (HMO’s and PPO’s) that are approved by Medicare but run by private health care providers. Medicare pays a monthly subsidy for beneficiaries who are enrolled in one of these plans, and the beneficiary also pays the private provider their Part B premium ($96.40) each month. Medicare Advantage Plans provide all Part A, Part B and (usually) Part D services to enrolled beneficiaries and MAY offer extra benefits like dental, vision and/or hearing. Although all medically necessary services provided by traditional Medicare, must also be covered by MA’s, they can charge different co-pays, co-insurance and deductibles.
- Cost: $0 -144.00 per month, plus the Medicare Part B monthly premium of $96.40 in 2009. If a beneficiary is considering a Medicare Advantage plan, they should look at the plan’s premium, co-pay, co-insurance and deductible structure before enrolling.
Medicare Part D – This is newest Medicare benefit, a result of the Medicare Modernization Act of 2003, and offers prescription drug coverage for all Medicare Beneficiaries.
- Cost: $15.20 – $106.70 per month in 2009. If you do not sign up when eligible and/or do not have creditable coverage, the beneficiary will be penalized 1% per month when they do enroll. Some beneficiaries are eligible for financial assistance for this benefit; LIS or “Extra Help” and Big Sky RX, Montana’s SPAP. In 2009, BSRX will pay up to $33.19/month for eligible beneficiaries.
Supplemental Insurance or “Medi-gap”
You may also have a Medigap policy or supplemental Insurance.
- 14 standardized plans A-L.
- Pick up “gaps” in Medicare coverage.
- A beneficiary may choose any supplement w/o obstacle, during the first (6) months of Part B eligibility.
- Call State Auditors office for more information 1-800-332-6148.
SHIP (State Health Insurance Assistance Program) – a local counseling and advocacy resource available to all Medicare beneficiaries, their families, service providers and many others who are interested in Medicare rights, options and benefits. The SHIPs have been in existence since 1992 (created to assist beneficiaries with understanding the standardization of Medicare Supplements) and provide expert, objective Medicare information/assistance/advocacy to beneficiaries in a one-on-one setting. To contact your local ship counselor, call 1-800-551-3191. Remember: SHIP counseling is free of charge.
WWW.Medicare.gov is another extremely useful resource:
- Prescription Drug Plan finder.
- Compare Part D plans.
- Review plan formularies, premiums and co-pays.
- Medicare Advantage Plans “Health Plan Compare”
- Compare Medicare Advantage plans.
- Review plan benefits, formularies, premiums, coinsurances and co-pays.
- My Medicare.gov
- Review your individual drug spend.
- Review your Medicare Summary Notices.
- Research your Medicare benefits, options and rights.
- Receive healthcare updates.
If you would like to locate your local SHIP counselor, please contact your local Area Agency on Aging at 1-800-551-3191.
If you need Medicare training or resources, please contact:
Kimme Evermann / Montana SHIP Director
kevermann@mt.gov
Brian Kelly / SHIP Program Officer
Bkelly3@mt.gov
THANK YOU!
