What is Medicare?
Medicare is a Federal health program that is available to most people over 65 years of age.  People who have Medicare and no additional health insurance are often referred to as having “Original Medicare” and are responsible for Medicare deductibles and coinsurance payments.  Therefore, most Medicare recipients opt to enroll in a private Medicare insurance policy.

When does my Medicare start? Or When do I enroll in Medicare?
Medicare typically starts the first day of the month you turn 65.  For example, Mary Smith was born July 3, 1942; her Medicare began July 1, 2007.  There are two common exceptions to this rule.  First, one can enroll in Medicare prior to turning 65 due to a disability.  Second, people born on the first day of the month receive their Medicare one month prior to their actual birth month.  To explain, Dixie Stone was born May 1, 1942; Dixie began her Medicare April 1, 2007. 

How can I be sure that my Medicare will start on schedule?
Folks should receive a letter from Medicare several months prior to their 65th birthday.  This letter mentions the start dates for Medicare Part A and Part B and often contains the Medicare claim number.  A letter of this type provides one with all the necessary information to complete any application for a Medicare insurance policy and, also, Medicare drug plans.  The Medicare card will arrive within a rather broad time frame, ranging from several months before or after your 65th birthday.  Should you be without a letter from Medicare or a Medicare card 30 days before your 65th birthday, either visit your local Social Security Office (call for an appointment) or call Medicare direct at (800) 633-4227.

What is the difference between Medicare Part A and Part B?
Medicare is divided into two portions, Part A and Part B.  Medicare Part A is the hospital portion of Medicare and is completely free, given automatically when one is eligible for Medicare.  Medicare Part B is the outpatient portion of Medicare, but Medicare Part B has a standard monthly premium of $115.40 (2011).  This premium is deducted from one’s Social Security check.  Furthermore, Part B premiums now depend on one’s gross income; folks with a higher income will pay more for their Part B.  One needs both Medicare Part A and Part B to enroll in any Medicare health insurance plan.

What is Medicare Part D?
Medicare Part D refers to the relatively new set of Medicare approved plans that cover prescriptions, only.  Part D plans are NOT standardized; that is, each Part D plan is unique with a distinct premium, formulary, and copayments.  One does NOT acquire a Part D plan from Medicare directly, rather the Part D plan is purchased from a private insurance carrier.  Part D insurance benefits are either issued as a distinct drug coverage policy or embedded into a Medicare Advantage Plan (a HMO, PPO, or PFFS (Private Fee-for-Service)). 

Can I postpone enrollment in Medicare Part B?
Yes, one can postpone enrollment in Medicare Part B.  However, we recommend that all folks enroll in Part B as soon as they are eligible; otherwise one must wait for a Part B open enrollment period (usually the following July) and also pay a permanent Part B premium penalty.  There is one exception to this recommendation, and this exception concerns folks who intend to keep their group insurance plan after the start of Medicare.  Active employees or retirees with a group insurance plan can postpone enrollment in Medicare Part B.  These group insurance members can, then, at any time disenroll from the group policy and acquire Part B without delay or a premium penalty.  We strongly urge folks to consult with Medicare directly should they want to postpone enrollment (for any reason) in Medicare Part B.    

What is Lock-in?
Lock-in refers to the Medicare rules that restrict movement from one Medicare Advantage Plan or Part D plan to another plan of the same type.  In brief, for much of the calendar year Medicare recipients are not allowed (locked-in) to cancel or change their Medicare Advantage Plan or Part D policy.  There are two different enrollment periods: the Annual Election Period (October 15 through December 7) and the Annual Disenrollment Period (January 1 through February 15).  The details concerning these enrollment periods are complex; you are welcome to call us, toll free, at (800) 404-4308 to ask specific questions about your situation.  The Medicare Lock-in rule does not apply to Medicare Supplement plans. 

Will I go through medical underwriting?
There is NO medical underwriting for enrollment in Medicare Advantage Plans.  There is also NO underwriting for enrollment in Medicare Supplement policies, provided the Medicare recipient enrolls within the first six months of receiving Medicare Part B.  However, one desiring to enroll in a Medicare Supplement plan after having been in Medicare for six months will be subject to a medical underwriting review.  There is no Preexisting Condition clause and no Waiting Period for any ongoing health concern once enrolled in either a Medicare Advantage Plan or Medicare Supplement policy.

What types of health insurance coverage are available to California Medicare recipients?
In brief, there are four insurance plan types available to California Medicare recipients.  These insurance plan types are as follows: HMO (Health Maintenance Organization) plans, PPO (Preferred Provider Organization) plans, Medicare Supplement (Medigap) plans, and Private-Fee-For-Service (PFFS) plans.  There are numerous health insurance plans for most of these plan types. 

What are the monthly premiums for the various Medicare plan types?
Monthly premium amounts are determined by the actual plan benefits and your county of residence.  HMO plan premiums vary, ranging from $0 monthly premiums in parts of southern California to upwards of $75 per month in key northern California counties.  PPO plan premium amounts range from $0 to $50 per month.  Medicare Supplement plans range in price from approximately $45 to $200 per month at age 65.  Medicare Supplement plans are the only policies that can assign premiums based on the subscriber’s age.  PFFS plan premiums range from almost $20 to $80 per month.  For a free price quote click here.

What does Medicare Cover?
Medicare provides coverage for some preventive care and services considered medically necessary.  Medicare Part A provides coverage for inpatient hospital care, inpatient skilled nursing care, some home health care, and hospice care.  Medicare Part B provides coverage for physicians’ services, outpatient care, physical therapy, speech therapy, some home health care, ambulance services, and approved medical equipment.  

What is NOT covered by Medicare?
Medicare, by itself, is not comprehensive.  Medicare has two distinct deductibles, the Part A hospital admission deductible of $1132 (2011), and the Part B outpatient deductible of $162 (2011).  Following payment of the deductibles, one pays 20% of all approved Medicare services.  Further, Medicare does not provide coverage for prescription drugs, hearing aids, eyeglass, and custodial care (Long Term Care).  Medicare recipients purchase health insurance to provide financial coverage for these Medicare deductibles and the 20% of each medical bill not paid by Medicare.  In addition, most Medicare health insurance plans also provide more coverage per benefit category than Original Medicare and, often, provide additional coverage such as eyewear.  Keep in mind that every Summary of Benefits will compare the health insurance plan benefits against Original Medicare so that you can understand the value of the plan itself.  If you have questions about Medicare or Medicare insurance plan benefits and premiums please call us at (800) 404-4308 or send us an email at StephenMVaughn@yahoo.com.

How do I enroll in a Medicare insurance plan?
To enroll in a private Medicare insurance plan, one completes the appropriate application and submits the application to our address:

Vaughn Insurance Agency, Inc.,
22287 Mulholland Hwy., #217,
Calabasas, CA  91302.

The only information that one will need from Medicare is the Medicare claim number (identification number) and the effective dates for Medicare Part A and Part B.  One does NOT need the actual Medicare card to complete a health insurance application; the Medicare claim number can be obtained from other, early correspondence from Medicare or over the phone from Medicare direct.  Applications for PPO (Preferred Provider Organization) and Part D plans do not require a check for the premium.  However, certain Medicare Supplemental plans require a check made out to the insurance carrier for the first month’s premium; please review your application for details.

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