Medicare is a health insurance program for:
- People age 65 or older
- Some people under 65 with disabilities
- People with End-Stage Renal Disease
For information about signing up for Medicare, call the Social Security Administration at 1-800-722-1213.
MEDICARE HEALTH PLANS:
ORIGINAL MEDICARE
Original Medicare is a “fee-for-service” plan. This means the beneficiary is generally charged a fee for each health care service or supply provided. This plan is managed by the Federal Government, and is available nationwide.
Original Medicare has two parts:
- Part A – Hospital Insurance that covers hospital, home health and skilled nursing stays
- Part B – Medical Insurance that covers a variety of outpatient services including medical supplies
Medicare has established eligibility and payment guidelines for Part B benefit:
- Monthly Premium - automatically deducted from Social Security check and amount changes every January 1st
- Annual Deductible – beneficiary is responsible for an annual deductible for Part B supplies or services beginning every January 1st
- Allowable Fee - the value determined by Medicare for the supply or service
- Medicare responsibility – 80% of allowable fee
- Beneficiary responsibility – 20% of allowable fee
MEDICARE ADVANTAGE
Medicare Advantage is a Managed Care Plan like an HMO. A private HMO administers each plan and ostomy coverage varies from plan to plan. Contact your HMO administrator for specific coverage guidelines.
MEDIGAP
Medigap is a health insurance policy sold by private insurance companies to fill “gaps” in the Original Medicare plan. Medigap policies must follow federal and state laws. The front of the Medigap policy must clearly identify it as “Medicare Supplemental Insurance”.
Each policy has a different set of benefits and deduction options. Medigap policies assist with beneficiary deductible and co-payment responsibilities for Original Medicare. You do not need a Medigap policy if you are in a Medicare Advantage HMO.