The PEBB rules and Medicare rules differ for those retirees that are under the age of 65 and enroll in Medicare. Some of the key points include:
-Many individuals who qualify to receive Medicare because of a permanent disability will also qualify for Medicaid coverage. This circumstance is very common for children. The majority of individuals that have Medicaid coverage are not allowed to enroll in Medicare Supplement plans.

-Those individuals who have ESRD (end-stage renal disease), do not have the option of changing their coverage to enroll themselves in one of the Medicare Advantage plans that is available.

-Some individuals ask the question, If I get Medicare because I m disabled , how will that affect my PEBB health insurance ? The rates are not the same for PEBB retirees who have disability Medicare and choose to have a Medicare Supplement plan as they are for the retirees that are over the age of 65.

PEBB requires notification if anyone in the household under the age of 65 has enrolled in Medicare. This allows PEBB to adjust the monthly premium for the household.

How Do I Pay for My PEBB & Medicare?

Individuals pay their PEBB rates on a monthly basis. It is just one piece of the health care bill. Individuals also have to pay their Medicare Part B premium on a monthly basis. There is usually no charge for Medicare Part A.

The majority of PEBB subscribers choose to have their premiums deducted on a monthly basis from their social security check. The premium for Medicare Part B increases in January of each year.

PEBB coverage works simultaneously with Medicare Parts A and B so an individual’s health care plan will continue providing comprehensive coverage.

Those individuals who continue to work and get Medicare can delay signing up for Medicare Part B until they decide to retire or leave work resulting in termination of their PEBB insurance plan.

What Determines Who Pays My Health Care Costs First?

The way your health care costs are paid depends on your status as a subscriber. It varies depending on whether you are retired, covered by PEBB insurance because you are still working, or no longer working.

1. If you are no longer working or retired but still covered by PEBB insurance, Medicare will pay first and then PEBB pays.
2. If you still work and are covered by PEBB insurance, PEBB will pay first and then Medicare pays.

Hopefully this answered your question – ‘ If I get Medicare because I m disabled , how will that affect my PEBB health insurance ?’

A Medicare Advantage plan is simply another option to supplement standard Medicare programs. If you are eligible for original Medicare, you are eligible for Medicare Advantage. Private insurers provide the Medicare Advantage plan and offer coverage in place of original Medicare. These private insurance companies must meet strict approval requirements and adhere to specific coverage standards.

Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) plans are the most common plan types for Medicare Advantage. With an HMO plan, an approved network of doctors and providers handle your health care, and any treatments received by an out-of-network provider are usually not covered, with the exception of emergency care. A PPO plan will cover out-of-network treatments at a reduced rate, which means you can see providers who are not in the network but you will pay more out of pocket for their services.

Why Choose Medicare Advantage?

Medicare Advantage plans cover additional services not provided for under original Medicare such as prescription coverage included in the premium, as well as hearing, vision and dental with some plans. Bundling this coverage in with your Medicare plan can save you money on premiums and out of pocket expenses, especially if you utilize those options frequently.

What Does It Cost?

Medicare Advantage plans vary in price depending on your coverage options and geographical location, but you can expect to pay a small monthly premium along with the premium for Medicare Part B coverage. You will also have some out of pocket costs when you receive treatments.

Other factors to consider when determining your total costs include deductible amounts, office visit copays, coinsurance and your annual out of pocket limits. Some services have caps on the number of visits, which can increase your out of pocket expenses, and you will pay more for providers who are not in the network.

While there are many cost factors to consider, you may be able to save substantially with Medicare Advantage versus original Medicare. The Medicare Rights Center states that premiums may be up to 80 percent lower than the cost of Medicare and Medigap combined, which can be about $250 per month.

When you take advantage of the extra benefits of vision, dental, hearing and prescription coverage, along with a lower monthly premium, you may be glad you took the time to ask, “What is a Medicare Advantage plan?”

http://www.medicarerights.org/

http://www.medicare.gov/

One of the many questions seniors will be required to answer when they become eligible for Medicare is, “Should I enroll in Medicare Part D for prescription drug coverage?” Before answering this important question, there are certain situations that can ensure seniors will be provided with their needed medications without having to signup for a prescription plan and there are other situations where enrolling in prescription coverage Part D should seriously be considered.

Employer Or Union Health Care Plans

Seniors who currently are receiving healthcare coverage from an employer or union that includes a Medicare approved prescription plan may find that the answer to “Should I enroll in Medicare Part D for prescription drug coverage,” will be no. Many sponsored healthcare plans offer prescription coverage that is similar to a prescription Part D plan. If a senior currently is covered by a sponsored healthcare plan, which does not carry Medicare approved drug coverage, joining a Medicare prescription plan should be considered when first becoming eligible. This will prevent a penalty of monthly premiums being increased by at least one percent.

Medigap Healthcare Coverage

Seniors who currently have a Medigap plan may or may not have prescription coverage depending on what state they currently reside in. States such as Wisconsin, Minnesota and Massachusetts do provide prescription coverage with their Medigap policies although most other states do not. If a prescription drug plan is not included in the Medigap policy, seniors can choose to signup for an approved Medicare drug plan. If the Medigap plan does provide a prescription plan, the participant must decide if this prescription plan will cover their medication needs or if it would be more beneficial to switch to a Medicare plan.

Medicare Advantage Plans

Seniors who choose to signup for original Medicare will have to decide if they also need a prescription drug plan. Most seniors do or will require medications at some time, which can be an enormous expense without a prescription plan. Seniors who signup for Medicare Part C, also known as an advantage plan, will usually find that Medicare Part D is included with their plan and will not need additional prescription coverage.

Avoiding Late Enrollment Penalties

When seniors are in good health and do not take prescription medications, they may consider not signing up for Medicare Part D during their initial enrollment period. Although this can save money if health problems do not occur, in the event Medicare Part D is needed, penalties will be applied depending on how many months have passed since the enrollment period.

Sources Medicare.gov, SeniorCorps.org, Caring.com

The answer to this question is, most likely, “Yes.” Medicare doesn’t cover the entire cost of medical services. The amount that Medicare will pay for a physician’s office visit is 80 percent and the patient will be responsible for the other 20 percent. Hospitalizations, especially if they are long-term, will be even more costly, but the Medicare coverage will only pay for a hospital stay that lasts one year.

Deductibles and Co-Payments

People also have other things they will need to pay for their Medicare coverage. Medicare Part A and Part B require that the insured pay a deductible. The deductible is the amount of money that will need to be paid by the patient before Medicare will begin to contribute. They may also be required to pay a coinsurance amount or a co-payment when they visit their doctors.

As people grow older, their need for medical care increases and the amount they are contributing toward their medical care can eat into a significant portion of their retirement income. If they believe that they will need extra help paying the 20 percent they are required to pay, their deductibles and their coinsurance or co-payments, they will want to answer the question, “Do I need a Medicare supplement plan?” with a “Yes!”

Types of Medigap Policies

The amount of the bills that Medicare doesn’t pay and leaves for the patient is called a gap, and secondary insurance has been given the name Medigap because it fills the gaps Medicare leaves behind. In the event that a patient has a hospital stay longer than one year, all Medigap plans pay for another full year.

The deductible for Medicare Part A will be paid in full when people purchase Medigap plans B, C, D, F, G and N. They will receive partial payment if they purchase Medigap plans K, L and M. With Medigap plans C and F only, people will also have their Medicare Part B deductibles paid in full.

People also have choices of Medigap plans that pay their coinsurance or co-payments. If they purchase Medigap plans A, B, C, D, F, G, M and N, they will have their coinsurance and co-payments paid completely. Medigap plans K and L make partial coinsurance and co-payments for Medicare Part B and for hospice care under Medicare Part A.

Do I need a Medicare supplement plan? Medicare recipients who are concerned that they may not be able to pay all of their medical bills will answer, “Yes.” When they do this, they will have several options to choose from that will help them pay the remainder of their bills.
Source: http://www.medigap.com/medigap-plans/

There is a multitude of information to consider when you are trying to decide which Medicare program(s) will work best for you. That is why knowing how Medicare works will help you in choosing the program(s) that best suits your needs.

Medicare Open Enrollment: October 15 – December 7, 2011

Each year, individuals who have Medicare have the option to look at new choices available to them. Then they can pick which plans will be the most beneficial for them. This year, Open Enrollment is from October 15th through December 7th, which is earlier than previous years.

What Does ‘Open Enrollment’ Mean?

Open Enrollment is the period of time you have to make changes to your Medicare plan for the upcoming year. You will have the opportunity to look at any other plans that are available for you and choose accordingly.

This year the Open Enrollment period is October 15th through December 7th.

-This means that October 15th is the first day that you can make any changes to your coverage for 2012.

-December 7th is the last day that you can initiate a new plan for 2012.

What is the Difference Between Medicare Parts A & B?

Medicare Part A = Hospital Insurance

Medicare Part A is used to cover inpatient care at skilled nursing facilities (does not include long term or custodial care), inpatient hospital care, home health care and hospice.

If you stay overnight in the hospital, it does not necessarily mean that you are considered an ‘inpatient.’ You are not considered an ‘inpatient’ until you are formally admitted into the hospital with an order from a doctor. Your out-of-pocket costs are affected depending on whether you are an outpatient or an inpatient.

Medicare Part B = Insurance for Services that are Medically Necessary, Medical Insurance

Medicare Part B is used to cover services such as outpatient care, doctors’ services, home health services, preventative services and various other medical services. It covers the supplies and services that are necessary to either diagnose or treat qualifying medical conditions.

Do Medicare Part A & Part B Cost the Same?

No, Medicare Part A does not usually have a premium since you probably paid Medicare taxes when you were employed, whereas, Part B does have a monthly premium that you must pay.

If you are not able to receive Part A without paying a premium, you could possibly purchase Part A if you qualify with one of the conditions outlined below:

-You are under 65, but you are disabled and your Part A coverage that was premium-free was terminated because you went back to work. It is important to note that if you are under the age of 65, and you are disabled, you can still receive Part A premium-free for up to eight and a half years after returning to work.

- You are 65 or older and are entitled to, or are in the process of enrolling in, Medicare Part B and meet the residency or citizenship requirements.

In the majority of cases, if you do purchase Part A, you must have Part B as well and pay the monthly premiums for each of them. If your resources and income are limited, the state you reside in may assist you in paying for your Part A and/or Part B Medicare coverage.

Is there a Premium for Part B?

Individuals that have Part B pay a monthly premium. Most will pay a standard amount. However, Social Security does contact some individuals who will be required to pay more because of their income. If you do not sign up to receive Part B when you first become eligible for Medicare, you may be charged a penalty if/when you do decide to purchase Part B Medicare coverage.

What Do I Have to Do to Start Receiving Part A?

You will be enrolled in Part A automatically unless you specify that you want to join Part C, which is a Medicare Advantage Plan.

Part A helps to cover only services that are considered medically necessary.

Do I Need Medicare Part A and Part B?

Part B Picks Up Where Part A Leaves Off

Medicare Part B picks up where Part A leaves off. If you have any kind of chronic condition that will require routine doctor visits or tests, it would be wise to consider obtaining both Parts A & B.

Medicare will not cover everything and does not cover the entire cost for a lot of the medical supplies or services that are covered. The amount covered is based on what Medicare plan you actually have. However, Part B will help provide additional health care coverage, which will help decrease the worry many experience concerning their medical costs.

No matter what coverage you choose, make sure you understand the coverage, options available and premiums.

Medicare can be a valuable asset to seniors and help ease the burden of medical expenses. The Medicare program, created in 1965, is the largest health insurance service in the United States with more than 40 million eligible active participants. Basic eligibility requirements include:

• 65 years of age or older
• Under 65 years or age with certain qualifying disabilities
• End-stage renal disease

How Do I Choose a Medicare Plan?

The first step in choosing a Medicare plan is to know what is available. Medicare is broken down into two main categories: Original Medicare Plan, Medicare Advantage Plan. Each category divided into four sub-categories: Part A, B, C and D.

Original Medicare Plan

The Original Medicare Plan includes Part A coverage. However, participants have the option to add Part B and Part D. Eligible seniors are automatically enrolled in this plan when they reach age 65 unless they choose to join a Medicare Advantage Plan or Part C. This plan, managed by the federal government, operates on a fee-for-service plan. Participants usually pay a deductible and co-pay or co-insurance.

Participants with Original Medicare may want to consider adding a Medicare Supplemental Policy referred to as Medigap. Participants must make a choice once they become eligible for Medicare. Participants may review their health and prescription needs once a year and switch to a different plan.

Medicare Advantage Plan

This plan, also called Plan C, combines Part A and Part B coverage. The Medicare Advantage Plan is provided by private insurance companies. You have the option to add Part D if such coverage is not already included. Medicare Advantage Plans include:

• HMO (health maintenance organization)
• PPO (preferred provider organization)
• Private fee-for-service plans
• Medicare special needs plans

Part A

This plan offers hospital insurance. Coverage is provided by Medicare. Most participants do not pay a premium for Part A coverage. Part A includes inpatient care such as hospital stays, critical access hospitals, skilled nursing facilities, hospice care and home health care.

Part B

This plan offers medical insurance designed to pay for services and supplies that are medically necessary. Coverage is provided by Medicare. Most participants pay a premium for this coverage. Part B coverage includes doctor’s services, outpatient care, occupational and physical therapy and other home health care services.

Part C

This plan combines coverage options from Part A and Part B. Part C coverage is provided through private insurance companies. However, these insurance companies must be approved by Medicare. Participants may have lower costs with this option along with additional benefits.

Part D

This plan is a stand-along plan for prescription drug coverage. Most participants are not required to pay a premium for this coverage. Plans vary with all medically necessary drugs covered in all incarnations of Part D coverage.

How Do I Cover Additional Expenses Not Covered By Medicare?

Additional expenses not covered by Original Medicare may include co-insurance, deductible, co-pays and prescription drug expenses. These additional expenses are called gaps. These additional costs may be covered by a Medigap policy.

Another option to help with additional cost is Medicaid. Medicaid combines federal and state programs to help cover extra medical costs. Eligibility for Medicaid is based on income and the participants ability to meet certain requirements.

What to Consider

Not all Medicare participants need additional coverage. Check to see what coverage you currently have with your insurance carrier and if this coverage can work with Medicare. All new participants will need to schedule a doctor’s appointment for a physical exam. At this point, decide what services you need and if you can afford to pay any additional expenses. You will then contact a Medicare representative to enroll. Some things to consider when determining which plan to choose include:

• What out-of-pocket expenses will you need to pay? Consider premiums, deductibles and prescription drug expenses. Two main options include an Original Medicare along with a Medicare Supplemental policy and Medicare Advantage Plans.

• Are additional benefits and services such as dental coverage, eye exams, hearing aids and other services covered outside of the United States? Some plans may include this coverage.

• Does the plan offer the prescription drug coverage you need? Compare plans to see what coverage is available and how much, if anything, you will be required to pay out-of-pocket.

• Can you see any doctor you choose?

• Do you need a referral for specialized care or to see a specialist?

• Are there restrictions on tests or procedures you can have done?

• Is the doctor reasonably close to where you live?

• Is there paperwork?

• Which hospitals or medical facilities are approved for your use if necessary?

• Are there restrictions on prescription drug coverage?

Once you know your options, determine your needs and choose a plan that meets those needs within your budget. With a little planning, Medicare can help ease the burdens often associated with health care.

Seniors always are aware of the need to save money on medical care costs and the expense of paying for regular prescriptions. One of the questions you may ask yourself is, how can I save money on my medical and drug costs?

Extra Help Program

One of the programs that many seniors are not aware of is the Extra Help program that is available through Social Security. The Extra Help program can help you cover the cost of Medicare drug coverage and other medical costs associated with your health care needs.

You will need to apply for the Extra Help program every year. It is available only to seniors who have limited income sources and limited sources for financial assistance.

Sources for Assistance

There are many different types of assistance available to help you save money. Each state has programs available for financial assistance for health care costs, provided you meet income and other requirements. For example, some states have programs for specific illnesses. Contact your state Medicare assistance department to find out about specific programs in your state.

Pharmaceutical companies also have assistance programs available for low income customers. You can go to pharmaceutical web sites to find out if they have a program available to help you with getting medications you need. In most cases, you will need to complete an application and have your doctor complete it and submit it for you.

Many local organizations also have financial assistance programs available to help seniors with the costs associated with their health care needs. Contact your local county health department to find out what programs are available in your area and what the requirements are for these programs.

PACE

Programs of All-Inclusive Care for the Elderly (PACE) is a program that provides assistance to help seniors stay in their homes instead of being places in elder care or nursing home facilities. This program will help you cover the cost of medications, doctor visits, in-home care, transportation, hospital stays and other expenses associated with your healthcare needs.

Medicaid

Medicaid is another program that is available for low income individuals. It can help seniors a great deal by providing not only lower medical care costs, but also by providing things like transportation assistance and personal care assistance.

If your income is higher than the income limitations to qualify for Medicaid, there are programs that are available if you qualify as “medically needy.” This program will allow you to deduct or subtract medical expenses from you qualifying income in order to become eligible for Medicaid.

Extra Help/Low Income Subsidy

Social security has a program available for individuals with exceedingly low income to help with prescription costs. This program has income qualifications and provides assistance by lowering medication costs to $2.50 per generic prescription and $6.50 for name brand prescriptions. Additional assistance can take the form of providing assistance in paying for Medicare drug programs.

Pharmacy Programs

Many pharmacies now offer programs that will provide you with lowered medication costs. It is important to price compare programs and look for the costs of your specific medications. It is a good idea to evaluate your prescription needs annually when you are also signing up for your Medicare coverage during open enrollment at the end of the year.

For generic drugs, pharmacies such as Walmart and Target offer much lower flat rates for a 30-day supply of medication. It may also save you money to use several different pharmacies for your medications.

Also consider signing up for and using a mail order medication program. In many cases, you can save a significant amount of money and get a 90-day supply of your medications.

Talk to Your Doctor

You should also talk to your doctor about your medication needs and the cost of medications. Your doctor can prescribe lower cost generic medications in order to save you money. In many cases, doctors also will be aware of prescription and other medical expense coverage limitations on specific plans if they are part of a managed care network.

There are many ways to save money when it comes to your medical care and medication needs. However, it is important that you be your own advocate and regularly evaluate your medical expenses and options for assistance. An annual evaluation of your needs can be performed during annual Medicare open enrollment at the end of the year. Most programs require you to apply annually in order to determine qualification.

With Senior Health Insurance Open Enrollment, seniors have opportunity to change, modify or enroll in Medicare benefits for an extended period of time. In 2011, mandatory enrollment period begins October 15th and extends through December 31st. At this time, qualifying applicants will either select a Medicare package that is right for them or make changes to their existing packages.

What Actions Can I Perform During Senior Health Insurance Open Enrollment?

• Patients may change from an Original Medicare Plan to a Medicare Advantage Plan.
• Patients may change from a Medicare Advantage Plan to an Original Medicare Plan.
• Patients may select a different Medicare Advantage Plan than the one they currently have.
• Patients may select a Medicare Advantage Plan that does offer a prescription drug Plan if their current plan does not offer a prescription drug plan.
• Patients may opt to cancel their prescription drug plan that accompanies the Medicare Advantage Plan if they currently have a prescription drug plan.
• Patients may join a Medicare Prescription Drug Plan three months before their 65th birthday or three months after their 65th birthday. Alternatively, during open enrollment, any senior can change, join or cancel a Medicare drug plan.
• Patients may select to change from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan.
• Patients may elect to cancel their Medicare Prescription Drug Plan.

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How Has Medicare Changed?

In 2010, Medicare lowered prescription drug costs, added wellness checkups and additional preventative care services. In 2011, the Affordable Care Act announced that cost-sharing expenses for mammograms, glaucoma tests, prostate cancer screenings and numerous other wellness checkups would be eliminated. Instead, Medicare will pay for annual check-ups, a physical examination and a comprehensive risk assessment. Seniors may also receive a personalized prevention plan.

Seniors are now eligible for coverage of their drugs up to $2840 after paying a $310 deductible. After the $2840 is reached, Medicare will cover 50% of the cost of brand name prescription drugs. This gap or lapse in coverage is often referred to as the “donut hole.” Additional discounts may also be given on brand name and generic prescription drugs.

After the patient reaches $4,550 out of pocket, the cost for prescription drugs will resume with a small co-payment. The Affordable Care Act, in 2010, will provide a $250 rebate for expenses in the coverage gap. By 2020, Medicare hopes to close the gap and only require the patient to pay 25% of the costs for prescription drugs.

Seniors enrolled in the Advantage Plan will have increased premiums, and Medicare Advantage Fee-for-Service Plans will no longer be available.

What Does Medicare Cover?

Medicare is designed for seniors age 65 and older. There are four parts of Medicare coverage: Part A, Part B, Part C and Part D.

Part A – Hospital Insurance. Part A is free for most enrollees that have worked a significant portion of their lives and paid Medicare taxes. This portion covers inpatient hospital care, admittance to a skilled nursing facility, hospice or home health care.

Part B – Medical Insurance. Part B covers medically necessary doctor’s visits, other outpatient care, home health services and other medical services. Part B also covers preventative services, such as the flu. Part B requires that you pay a premium each month. Some people may have to pay more depending upon their income. A social security representative will contact you if this applies to your situation.

Part C – Medicare Advantage Plan. The Medicare Advantage Plan is more like an HMO or a PPO. These plans are offered by private companies, but are approved by Medicare. This plan will include your Hospital Insurance (Part A) and Medical Insurance (Part B). The Medicare Advantage Plans will also offer extra coverage, including vision, dental, hearing and other wellness programs.

There are numerous Medicare Advantage Plans, so the patient’s out-of-pocket expenses will vary based upon the private company’s charges. Deductibles, monthly premiums, copayments, annual fees and out-of-network fees will all factor into your total out-of-pocket expenses.

Part D – Prescription Drug Coverage. Medicare provides prescription drug coverage to everyone with Medicare. Medicare recipients can enroll in the prescription drug coverage any time between October 15th and December 7th.

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If you do not enroll when you are eligible, you will probably pay a late enrollment fee. Most seniors enroll in private plans approved by Medicare. The plan costs will vary based upon the cost and drugs covered. There are four different plans available: Original Medicare, Medicare Cost Plans, Medicare Private Fee-for-Service (PFFS) and Medicare Medical Savings Account (MSA) Plans.

References:

 http://www.medicare.gov/navigation/medicare-basics/open-enrollment.aspx
 http://www.medicare.gov/navigation/medicare-basics/medicare-benefits/medicare-benefits-overview.aspx
 http://healthinsurance.about.com/od/medicare/a/understanding_part_d.htm