Skip directly to content

APPRISE - FAQ

Frequently Asked Questions (FAQs)

Seeking the best Medicare coverage can be confusing.  Below are listed some commonly asked questions along with simplified answers.  If you still need clarification or you need our Apprise counselors to expand on the subject, please contact duhler@rsvpmc.org   to schedule an appointment.

 

Why do I need more than just Medicare?
Medicare provides hospital insurance coverage, hospice care, medically necessary home health care, and skilled nursing care through Medicare Part A coverage.  There is a deductible each benefit period. If you go into skilled care, there will be a co-pay for days you stayed beyond the 20th day. Medicare Part B coverage helps with physician services, outpatient care, certain home health care, therapy, lab and diagnostic tests and durable medical equipment. There is a monthly premium and a yearly deductible. You pay 20% of the Medicare approved amount for the care you receive. These costs can add up.  Medicare Advantage plans or Supplement (Medigap) plans are available to help cover some of these costs. Medicare does not cover prescriptions. A prescription drug plan may be a good choice to help with the cost of the outpatient drugs.

 

Can I keep my employer’s health plan?
Yes you may keep an employer’s insurance. If you are still working and your employer’s insurance covers your Medicare Part B needs (physician services, outpatient care, certain home health care, therapy, lab and diagnostic tests and durable medical equipment), you may choose to not have Part B while you are continuing to work. Always check with your plan’s benefit administrator. Medicare is primary and employer plan is secondary if your company has less than 20 employees.  If you are on Medicare because of disability Medicare is primary if your company has less than 100 employees. You have an 8 month special enrollment period to enroll in Part B without penalty if you lose your job and employer coverage. You have only 63 days to enroll in the Part D plan without penalty.

 

How much does Medicare cost?
Part A of Medicare (hospital insurance coverage, hospice care, medically necessary home health care, and skilled nursing care) is provided to most people at no cost because they or their spouse has 40 or more quarters of Medicare covered employment. Medicare is available at a cost for those who did not work the required quarters. Part B coverage has a monthly premium of $104.90. This amount comes out of the social security check before you receive your check. If your income as an individual is above $85,000 or above $170,000 as a married couple, you will probably pay more each month for the Part B coverage. Part B also has a $147 yearly deductible in 2013.

 

What are Medicare Advantage Plans?
Medicare Advantage plans are usually HMOs or PPOs approved by Medicare but offered by private companies. The plans are sometimes referred to as Part C of Medicare. These plans are not supplemental plans to Medicare. The Medicare Advantage plan becomes the provider of your health care and usually your drug coverage. XXX I took out one sentence You will have a monthly premium and co-pays involved with your coverage. They sometimes offer extra coverage that Medicare does not provide. These may include extra help with vision, hearing, and dental needs. Some of the plans require a referral before seeing a specialist or having a test performed.

 

Can my wife and I have a joint plan?
No, you can not have a joint plan with Medicare. Each of you is considered an individual, often with differing needs so each of you may choose the coverage that best suits your needs.

 

Will Medicare pay for my mother’s stay in the nursing home?
Medicare covers skilled nursing care in a hospital or nursing home following a three day in-hospital stay. To receive the skilled care, the doctor must certify that you need daily skilled care. Medicare covers up to 100 days of skilled nursing care, but there are co-pays for services from day 21-100. Most folks seldom need daily skilled care beyond the 20th day. Medicare does not pay for custodial care. Custodial care might include help going to the bathroom, dressing, eating, and transferring from chair or bed and other non medical assistance. Medicare will continue to pay for medical needs while in the nursing home.

 

I don’t like my drug plan, can I change it now?
In most cases you must stay with the plan you have during the calendar year. If you are with a Medicare Advantage plan that offers drug coverage you will need to stay with their plan. If you choose a stand alone (PDP) drug plan you will be dropped from your health insurance. There are certain situations that may enable to you to change plans. If you move out of the service area of your drug plan you will be able to choose a new plan. If your plan stops offering prescription drug coverage you can enroll in a new plan. If you enter or leave a nursing home there is an opportunity to change plans. If you are now assigned to a plan through the Extra Help (LIS) Program you can change your plan to one that suits you better. Most people study the options available and change plans from Nov 15 to Dec 31 to be effective. Jan 1st.

 

I lost my Medicare card. Can I get a new one?
Yes, you can get a replacement card. If you call Social Security at 1-800-772- 1213 or go to the online social security website www.ssa.gov you will be able to apply for a new card. It should arrive in about 4 weeks.