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The New Improved Medicare Chapter 2
Medicare Parts A and B
What Is Medicare Part A?
Medicare Part A, called Hospital Insurance, helps cover the participants inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities. It does NOT cover custodial care in a nursing home. Part A also helps cover hospice care and some home health care services. In all cases, the beneficiary must meet Medicare requirements in order to receive this coverage.
Most people do not pay anything to receive Part A services. In most cases, either the patient or the patients spouse qualified for the coverage through their work history by paying Medicare taxes. If an individual did not pay adequately into the system during their working years they may be able to purchase it if: Neither the individual nor their spouse are entitled to Medicare because neither person worked or did not pay enough Medicare taxes while they did work, or The individual is disabled but no longer receiving free Part A since he or she returned to work.
Those individuals with limited income and resources may receive financial help from their resident state to pay for Part A premium if he or she did not qualify to receive it free. Medicare participants will have a membership card that is white with a red and blue strip across the top. It will state:
Hospital (Part A) [Effective date]Medical (Part B) [Effective date]
Medicare Part A helps cover the participants medically necessary: Hospital stays, including a semiprivate room, meals, general nursing, and other hospital services and supplies. This would include inpatient care that is received in critical access hospitals and mental health care. This would not include private duty nursing, or television or telephone services in the room if it were not included in the daily room rate. Private rooms are not covered unless there is a medical reason to have one. Inpatient mental health care in a psychiatric facility is limited to 190 days during the patients lifetime. Skilled Nursing Facility Care, which includes a semiprivate room, meals, skilled nursing and rehabilitative care, and other services and supplies after a related three-day inpatient hospital stay. Medicare does not pay for any type of care that is not skilled care. Statistically most people in a nursing home require custodial or personal care; that is not paid for by Medicare nor will a Medigap insurance policy pay for such care. Home Health Care, which is limited to reasonable and necessary part-time or intermittent skilled nursing care and home health aide services as well as physical therapy, occupational therapy, and speech-language services that are ordered by the patients doctor and provided by a Medicare-certified home health care agency. Medicare Part A will also pay for medical social services and durable medical equipment, such as wheelchairs, hospital beds, oxygen, and walkers, along with other medical supplies and services. Hospice care is covered for participants with a terminal illness. This care includes drugs for symptom control and pain relief, medical and support services from a Medicare-approved hospice company, and other services not otherwise covered by Medicare, such as grief counseling. Hospice care is typically provided in the patients home or the home of their caregiver (often their childs home). It can also be provided in a nursing facility if it is the patients home. Medicare covers some short-term hospital and inpatient respite care if it is being provided so that the normal caregiver can rest or take a vacation. Blood is covered by Medicare Part A if it is provided in a hospital or skilled nursing care facility during the patients approved stay.
Medicares hospitalization benefits include deductibles and copayments:
The actual amounts of the deductibles and copayments under Part A change from year to year but they do have some common elements no matter how much the deductible is:
To put this in dollar figures, if the first 60-day deductible were $100 (its not; the actual figure is around $1,000), then the daily deductible for 61-90 days would be $25 (1/4 of the 60-day deductible). The daily deductible for 91-150 days would be $50 (1/2 of the 60-day deductible). The figures used in this example are not actual deductible amounts. They change from year to year and we prefer not to enter actual figures for that reason.
Medicare will cover skilled nursing facility care. It is important to understand that Medicare does not pay for any level of care other than skilled. It does not pay for either custodial or intermediate nursing care. Custodial care is often called personal or maintenance care. Such care is non-medical in nature and often required for an extended period of time. People with dementia or Alzheimers disease require custodial care rather than skilled care. Skilled nursing facility care has three benefit periods under Medicares guidelines:
Deductible amounts can change from year to year. If changes do occur they will become effective on January 1.
To qualify for nursing facility care under Medicare, the following conditions must be met: The doctor must certify that the care prescribed is necessary. Skilled nursing and skilled rehabilitative services must be required on a daily basis. The facility must be Medicare certified. The facilitys Utilization Review Committee must not disapprove the stay. The care must be rehabilitative meaning the care must be designed to improve the patients physical condition.
It cannot be stressed enough that Medicare pays ONLY skilled care; Medicare does not cover custodial and intermediate care. Individuals interested in having coverage for these two levels of care must purchase a private long-term care policy from a private insurance carrier.
When receiving home health care under Part A of Medicare there can be much confusion on which services will be paid for. Part A will pay the full cost of medically necessary home health visits if the beneficiary is homebound, meaning he or she is unable to do an outside normal routine of shopping and general errands and appointments. Coverage would include: Part time (never full-time) skilled nursing care; Physical therapy, and Speech therapy.
If the beneficiary requires any of these services, is confined to their home (homebound) and is under the care of a doctor, then Part A may also be able to provide other services, including part-time or intermittent home health aid services for: Skilled nursing care; Occupational therapy; Medical social services; and Medical supplies and equipment provided by Medicare-certified agencies.
Coverage can also be provided for a portion of the cost of durable medical equipment provided under a plan of care set up and supervised by the patients physician.
Medicare does not cover all costs. Items not covered include: Full-time nursing care in the home; Drugs and biologicals; Meals delivered to the home; Homemaker services, such as cleaning or cooking; General daily maintenance care, such as help with bathing, dressing or transferring in and out of beds or chairs.
The amount of visits from home health personnel is unlimited as long as the patient meets all of the requirements set down by Medicare. The patient pays nothing since Medicare will cover all eligible costs (although the patient will have to pay 20% of reasonable charges for durable medical equipment). It is important to note that only care considered eligible under Medicares guidelines are covered. In order to be considered eligible charges: A doctor must certify the need for home care; The treatment must require only part-time skilled nursing care or physical, speech, or occupational therapy; and The patient must be termed home-bound meaning he or she is unable to perform a normal routine of shopping and general errands; and A doctor must set up a home health care plan that is provided by a Medicare-certified home health care agency.
When hospice benefits are required it means the patient is terminally ill he or she is expected to die within a set period of time. Medicare beneficiaries certified as terminally ill may choose to receive hospice benefits. Part A will pay for two 90-day hospice benefit periods, a subsequent period of 30 days, and a subsequent extension of unlimited duration.
When a Medicare beneficiary enrolls in a Medicare-certified hospice program he or she receives medical and support services necessary for symptom management and pain relief. It is most common for these services to be provided in the patients home or the home of their caregiver, usually a child. When a Medicare certified agency provides the care, the coverage will include: Physician services, Nursing care, Medical appliances and supplies, such as drugs for symptom management and pain relief, Short-term inpatient care, Counseling, Therapies, and Home health aides and homemaker services.
Medicare Part A and B deductibles do not apply to services and supplies that are furnished under the hospice benefit program. There are limited charges for outpatient drugs and inpatient respite care. When services are required that are not related to the hospice care, then regular Medicare benefits would apply, including any applicable deductibles and copayments.
In order to qualify for hospice benefits the patient must be diagnosed as terminally ill, having only six months or less to live and receive their care from a Medicare certified hospice program.
What Is Medicare Part B?
Medicare Part B, called Medical Insurance, helps cover a participants doctors services and outpatient care. It also covers some other medical services that Part A does not cover, such as physical and occupational therapists, and some home health care. In all cases, any care received must be considered medically necessary as defined by Medicare. Medicare defines medically necessary as services or supplies that are needed for the diagnosis or treatment of the patients medical condition, provided for the diagnosis and treatment of the medical condition, meet the standards of good medical practice in the local area, and is not mainly for the convenience of the patient or family members.
Where Part A of Medicare is usually free since it was earned during ones working years, Part B of Medicare is optional and must be purchased. The premium is deducted from the recipients Social Security check each month. The actual dollar amount can vary from year to year. If the recipient did not sign up for Part B at the time he or she was first eligible to do so the cost may be higher by 10 percent for each full 12-month period that he or she could have had Part B but didnt sign up for it. There are exceptions to this lifetime penalty if creditable coverage was being received elsewhere (usually through employment).
There is a deductible each year before benefits will be received from Part B coverage. Like the premium rate, the deductible can change each year with any changes becoming effective on January 1.
Medicare Part B covers medically necessary: Medical and other services, such as doctors services, outpatient medical and surgical supplies, diagnostic tests, ambulatory surgery center facility fees for approved procedures, and durable medical equipment, such as wheelchairs, hospital beds, oxygen and walkers. It also covers a second, and sometimes a third, surgical opinion for surgery that is not an emergency, outpatient mental health care, and outpatient occupational and physical therapy, including speech-language services. Clinical Laboratory Services, such as blood tests, urinalysis, and some screening tests. Home Health Care that is limited to reasonable and necessary part-time or intermittent skilled nursing care and home health aide services as well as physical therapy, occupational therapy, and speech-language therapy ordered by the doctor and provided by a Medicare-certificated home health agency. It also pays for medical social services, durable medical equipment such as wheelchairs, hospital beds, oxygen and walkers, medical supplies, and other services. Outpatient Hospital Services and supplies received as an outpatient under the supervision of a doctor. Blood is covered that is received as an outpatient or as part of a Part B-covered service.
Medicare Part B Preventive Services To help recipients stay healthy and find health problems early, specific treatments and services are covered: Bone Mass Measurements: these measurements help determine if an individual is at risk for broken bones. Medicare covers these measurements once every 24 months for those at risk for osteoporosis. It may be covered more often if medically necessary. Cardiovascular Screenings: physicians may do testing for cholesterol, lipid, and triglyceride levels so he or she can help prevent heart attacks and strokes in their patients. Medicare covers screening tests for cholesterol, lipid and triglyceride levels every five years. Colorectal Cancer Screening: these tests help find pre-cancerous growths so they can be removed and prevent cancer. They also help find colorectal cancer early, when treatment is most effective. If the beneficiary is age 50 or older or at high risk for colorectal cancer, one or more of the following tests is covered: Fecal Occult Blood Test, Flexible Sigmoidoscopy, Screening Colonoscopy, and/or Barium Enema. How often Medicare pays for these tests depends on the test the doctor feels is best for his or her patient and the patients level of risk for cancer. Diabetes Screenings: tests to check for diabetes are covered by Medicare. These tests are available if the patient has any of the following risk factors: high blood pressure, a history of abnormal cholesterol and triglyceride levels, obesity, or a history of high blood sugar. Medicare also covers these tests if the patient has two or more of the following characteristics: age 65 or older, overweight, family history of diabetes, or a history of gestational diabetes (diabetes during pregnancy). Depending upon the results of these tests, the patient may be eligible for up to two diabetes screenings each year. Flu Shots: Medicare will cover flu shots to prevent influenza or the flu virus. These are covered once per flu season in the fall or winter. Glaucoma Tests: these tests help find the eye disease glaucoma. Medicare covers this test once every 12 months for those at high risk. Hepatitis B Shots: These three shots help protect people from getting Hepatitis B. Medicare covers these shots for those who are at high or medium risk for Hepatitis B. Pap test, Pelvic Exam, and Clinical Breast Exam: the Pap test and pelvic exam checks for cervical and vaginal cancers. Medicare covers these exams every 24 months for women. They are covered every 12 months for those considered at high risk. Pneumococcal Shot: this shot helps prevent Pneumococcal infections. Medicare covers this shot for all their beneficiaries. Most people only need this shot once in their lifetime. Prostate Cancer Screening: this test is used to find prostate cancer. Medicare covers a digital rectal exam and Prostate Specific Antigen (PSA) test once each 12-month period for men on Medicare who are age 50 or more. Screening Mammograms: these tests check for breast cancer. Medicare covers mammograms once every 12 months for women age 40 or older who are on Medicare. Welcome to Medicare Physical Exam: This is provided one time only. It is a review of the patients health, as well as education and counseling about the preventive services available, including certain screenings and shots. Referrals for other care, if needed, are included. NOTE: the physical exam must be obtained within the first six months that the individual is on Medicare Part B. If he or she fails to schedule and receive the exam during that time period, they will lose the benefit.
Medically Necessary Services and Items Covered by Medicare The following are commonly needed services and items that Medicare will pay for. For services that are not listed, but may be desired, the beneficiary may call 1-800-633-4227 to talk with a Medicare representative about it. This will not guarantee coverage of services but it may provide some indication of the possibilities. Usually the following services are covered: Ambulance Services: when it is medically necessary to be transported to a hospital or nursing facility and transportation in any other vehicle would endanger the patients life Medicare will pay for this. Medicare will not pay for transportation to or from the doctors office or to and from an outpatient service for routine care. Chiropractic Services: manipulation of the spine to correct a subluxation. Clinical Trials: routine costs if the beneficiary takes part in a qualifying clinical trial. Medicare will not cover the costs of experimental care, drugs, or devices being tested in a clinical trial. Diabetic Self-Management Training: this is covered for certain people who are at risk for complications from diabetes. The participants doctor must request the service. Diabetic Supplies: glucose testing monitors, blood glucose test strips, lancet devices and lancets, glucose control solutions, and therapeutic shoes in some cases. Syringes and insulin are not covered unless used with an insulin pump. These would be covered under a Medicare Prescription Drug Plan, however (Part D). Durable Medical Equipment: this would include such items as oxygen, wheelchairs, walkers, and hospital beds when used in the home under the direction of a physician. Emergency Room Services: when a participant believes their health is in serious danger, he or she may consider emergency room services as medically necessary. This would include care for an injury, sudden illness, or an illness that is quickly worsening. Eyeglasses: limited to one pair of eyeglasses with standard frames after cataract surgery that includes implanting an intraocular lens. Foot exams and Treatment: this would be covered for those with diabetes-related nerve damage who meet certain Medicare required conditions. Hearing and Balance Exams: covered only if the patients doctor orders them to see if medical treatment is needed. Medical treatment is not the same thing as a hearing loss. Medicare will not cover the cost of hearing aids or exams for fitting hearing aids. Kidney Dialysis Services: kidney dialysis and services and supplies are covered either in a facility or at the patients home. Long-Term Care: Medicare will cover only skilled care given in a certified skilled nursing facility or in the patients home. Medicare does not cover custodial or intermediate nursing care. Medical Nutrition Therapy Services: for those who have diabetes, or kidney disease (except for those on dialysis) this will be covered for three years after a kidney transplant as long as it comes from a doctors referral. Mental Health Care: inpatient or outpatient care may be received. There are certain limitations and conditions that apply. Practitioner Services: these are services such as those provided by clinical social workers, physician assistants, and nurse practitioners. Prescription Drugs: Part B covers limited prescription drugs, like certain injectable cancer drugs. Complete information may be obtained from Medicare. Prosthetic/Orthotic Items: this includes arm, leg, back, and neck braces, artificial eyes, artificial limbs and their replacement parts, breast prostheses after a mastectomy, prosthetic devices needed to replace an internal body part or function, such as ostomy supplies. Second surgical opinions: this is covered in some cases. Smoking Cessation Counseling: inpatient or outpatient services, up to eight face-to-face visits during a 12-month period if the patient is diagnosed with a smoking-related illness that requires him or her to stop smoking or using tobacco. Surgical Dressings: these are covered if required for treatment of a surgical or surgically treated wound. Telemedicine: these services are covered in some rural areas. Tests: such things as X-rays, MRIs, CT scans, EKGs, and some other diagnostic tests are covered as long as they are medically necessary. Transplant Services: Medicare covers heart, lung, kidney, pancreas, intestine, and liver transplants under specific conditions. Immunosuppressive drugs are covered if the transplant was paid for by Medicare, or paid by an employer group health plan that was required to pay before Medicare would pay. The patient must have been entitled to Part A at the time of the transplant and be entitled to Part B at the time he or she gets immunosuppressive drugs and the transplant must have been performed in a Medicare-certified facility. Travel Outside of the United States: Medicare pays for services provided in Canada when the participant is traveling between Alaska and another state. Medicare also covers hospital, ambulance, and doctor services if the beneficiary is in the United States, but the nearest hospital that can treat the patient is not in the US. The United States includes all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, American Samoa, and services received while on board a ship in the territorial waters adjoining the land areas of the United States. Urgently Needed Care: this is care that is received for a sudden illness or injury that is not a medical emergency.
These items and services are covered no matter what kind of Medicare plan the participant enrolls in. The amount that Medicare pays will depend, however, upon the type of plan selected. Advantage plans pay differently in many cases, for example, than Original Medicare plans.
Medicare Part B does not cover everything. The following items and services are generally not covered: Acupuncture. Deductibles, coinsurance, or copayments that are due on services or items received. Dental care and dentures. Cosmetic surgery. Custodial care, which is help with the daily activities of life, such as bathing and using the bathroom. Eye refractions. Health care received while traveling outside the US, except as previously listed. Hearing aids and hearing exams for the purpose of fitting a hearing device. Hearing tests that have not been ordered by a physician. Long-term care that is outside of what is covered for skilled nursing services under specific conditions. Orthopedic shoes (although there are a few exceptions). Prescription drugs, except for specific exceptions. Routine foot care, such as cutting of corns or calluses. Routine or yearly physical exam, except for the Welcome exam during the first six months of Medicare benefits. Screening tests and screening laboratory tests that are outside of what is specifically covered. Vaccinations that are not on the covered list. Some diabetic supplies, like syringes or insulin unless the insulin is used with an insulin pump or the beneficiary joins a Medicare Prescription Drug Plan.
Medicare prescription drug coverage helps the beneficiary with prescription drug costs. The participant must choose a plan to get this coverage. The prescription drug coverage (Part D) will charge a monthly premium for the coverage, but the amount of that premium will vary depending on the plan chosen. Those who have limited income and resources may be able to obtain this coverage for little or no cost. Those who have prescription drug coverage through an employer or union should discuss their options with the benefits administrator to see if it would be wise to also join a Prescription Drug Plan (PDP).
When a Medicare participant also has drug coverage through an employer or union plan that meets Medicares standards, this is called creditable coverage. When creditable coverage exists it will not be necessary to join Part D of Medicare because there will not be a penalty for waiting. This is ONLY true when creditable coverage exists elsewhere. If the employer or union stops offering creditable prescription coverage, the individual will have a Special Enrollment Period to sign up for a Medicare Prescription Drug Plan. Unless there is a creditable drug plan, the Medicare beneficiary would have a lifelong penalty for signing up late for Part D. Late enrollment means signing up after first eligible for the benefit or after May 15, 2006 if on Medicare prior to that date. All prescription drug plans approved by Medicare use a seal on their materials:
Medicare Rx Prescription Drug Coverage
Those who choose to use the standard Medicare that we have been accustomed to (now called the Original Medicare Plan) will be using Parts A and B of Medicare. Even if an individual decides to use that plan, he or she may also sign up for prescription coverage under Part D. It is likely that their Medigap insurer will offer this coverage, but if not, it is not necessary to change plans. Even if the beneficiary purchases the coverage from the same insurer it will be a separate policy, so it wont matter if they have one company for Parts A and B and another company for Part D benefits. In other words, a Medicare beneficiary may keep their Medigap policy and purchase drug benefits from a different insurer if they wish to.
Beneficiaries will automatically keep their Original Medicare Plan unless they specifically choose to join a Medicare Advantage Plan under Part C of Medicare. The Original Medicare Plan is a fee-for-service plan that is managed by the Federal Government.
The rules for how the Original Medicare Plan works are: 1. The participant uses their red, white, and blue Medicare card anytime they seek out covered medical services. 2. If the participant has Part A, he or she will get all the Part A-covered benefits offered by Medicare. 3. If the participant has purchased Part B, he or she will get all the Part B-covered services offered by Medicare. There is a premium charge for Part B services that is automatically deducted from the individuals Social Security check each month. 4. Those on the Original Medicare Plan may go to any doctor, hospital, or supplier that accepts Medicare patients and participates in Medicare. 5. The participant will pay any deductibles that are required by Medicare before Medicare begins paying. The participant will also be responsible for any copayment or coinsurance that is due. If he or she has a Medigap insurance policy, the policy will pay these amounts.
When the beneficiary receives a health care service, he or she will receive a Medicare Summary Notice (MSN) in the mail. These notices are sent by the companies that have contracted to handle the bills for Medicare. The notice lists details of the services received by the beneficiary and the amounts the beneficiary is responsible for.
Some services may be listed on a separate MSN, such as Part B drugs for certain cancer drugs. This claim will let the beneficiary know whether or not Medicare approved the drugs the doctor administered in his office. If the bill is partially or totally denied, the beneficiary can file an appeal. The beneficiary will receive information from his or her doctor on how to ask for an appeal. This information is also on the MSN.
Medicare Part B Will Not Pay For Everything What a person actually pays out-of-pocket will depend upon several things: 1. Whether the beneficiary has Parts A and B, as most people do. 2. Whether the physician or medical supplier accepts assignment. 3. How often the patient needs the particular type of health care. 4. The type of health care being received. 5. Whether the beneficiary is receiving a type of service that is accepted by Medicare for payment. If it is not, then the beneficiary will be responsible for all the costs. 6. Whether the beneficiary has other health insurance that will pick up what Medicare does not pay.
Most insurance professionals and Medicare specialists advise those on the Original Medicare Plan to seek out physicians and other providers that will accept what is called assignment. Assignment means that the provider will accept what Medicare approves on the charge. It is important to note that Medicare does not fully pay the amount they approve; they pay only 80 percent of that amount. The patient is responsible for the remaining 20 percent of the approved charge unless he or she has insurance that will pay that portion.
Example: Marjorie Medicare Patient goes to her doctor for a covered service. He charges her $100. Of that $100, Medicare approves $60 and then pays 80 percent of that amount or $48 (80% of $60 = $48). Marjorie or her insurer is responsible for the difference between what Medicare paid and what the doctor charged (although the limiting charge will apply). $100 - 48 $ 52
If Marjories Medigap policy covers only approved charges, then her policy will pay only the difference between $60 and $48 or $12 (the amount remaining of the approved charges). $60 -48 $12
If Marjorie has a Medigap policy that pays the entire bill, regardless of what Medicare actually approves, we would expect it to pick up the remaining $52. However, there is a law that limits what the doctor may charge his Medicare patients. Even if he normally charges his non-Medicare patients $100 for the service, he may charge his Medicare patients no more than 115 percent of the amount approved by Medicare. This is called the limiting charge ($60 X 115% = $69). Medicare already paid $48. Therefore Marjories insurance policy will only be required to pay $21 rather than the $52 it would have otherwise paid. Many medical providers limit the number of Medicare patients they see because they realize they will not receive full payment for their services. In this case, the doctor loses the difference between the $100 he would normally receive and $69, the amount capped by the limiting charge. $ 60 X115%$ 69
$100 - 69 $ 31 lost revenue
Not every service is affected by the physician limiting charge. It does not apply to supplies and some items.
Some states require physicians to accept Medicare assignment ($60 out of $100 in our example); they do not have the option of charging more than the approved amount for their Medicare patient services. Some types of services must accept assignment in all states because federal law mandates it.
In most cases, doctors and other suppliers must submit the beneficiaries claims to Medicare for them. There are some exceptions to this: if the participant gets his or her Medicare Part B-covered prescription drugs or supplies from a supplier or pharmacy not enrolled in the Medicare program, for example, then the participant will probably have to send in their claim to Medicare themselves. The doctors and suppliers that bill Medicare for their patients are not allowed to bill their patients for this service.
Most people who opt for the Original Medicare Plan do also buy a private insurance policy, called a Medigap policy. While there were ten standardized plans, as of January 2006 three of the original ten are no longer offered for sale (insurers are prohibited from doing so). Medigap Plans H, I, and J (numbers 8- 10) offered prescription drug benefits. With the creation of Part D prescription drugs, it was felt that Plans H, I, and J were at odds with the offering of Part D. There are still multiples choices available, however, including newly introduced Plans K and L that were designed to offer a lower premium.
Medigap policies, which are offered by private insurance companies, must follow all state and federal laws. Policies may differ from state to state since not all state laws are uniform. Federal laws will mostly be uniform among all the states. Only if the state laws are more restrictive providing higher protection for its citizens will those laws override any lesser federal laws. In all states except Massachusetts, Minnesota, and Wisconsin, a Medigap policy must adhere to one of the standardized forms (A-L). Any standardized policy may be sold as a Medicare SELECT policy. Medicare SELECT policies typically cost less because specific hospitals and, in some cases, specific doctors must be used to get full insurance benefits from the policy. In an emergency the beneficiary may use any doctor or hospital.
Under the Original Medicare Plan supplemented by a Medigap policy the insured can go to any doctor, specialist, or hospital (except under SELECT plans). Medicare pays its share followed by the Medigap policy, which will pay its contracted share. The amount covered by the Medigap policy will depend upon the standardized plan selected by the beneficiary. The insured pays both the Part B premium and the insurance premium. As services are received, the insured will receive a Medicare Summary Notice each month in the mail. It will summarize how Medicare made payment and show how much was left owing.
If a Medicare participant had already purchased one of the three standardized Medigap plans covering prescription drugs (Plans H, I and J) before the Medicare Prescription Drug Plan became available, he or she can keep it. Following the point in time when PDPs became available, these three plans were not offered for purchase. Most experts recommend that those with Medigap prescription plans drop the prescription coverage and convert to a Medicare Part D Prescription Drug Plan since it is likely to be less expensive considering the high deductibles in Medigap Plans H, I, and J.
Some Medicare Advantage Plans (MA) may pay all or part of an individuals Medicare Part B premium. This would mean opting out of the Medicare Original Plan and utilizing Part C managed health care. The individual would still receive both Parts A and B benefits.
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