NC Medicare Supplement & Long-Term Care Insurance Licensing Already Rated A+

NC Medicare Supplement & Long-Term Care Insurance Licensing Already Rated A+ Medicare Health insurance for those over age 65, people under 65 with certain disabilities & those with ESRD (end stage renal disease - permanent kidney failure requiring dialysis or kidney transplant) CMS Centers for Medicare and Medicaid Services administers the Medicare program. Social Security Administration handles most of the enrollment & plays a role in claims appeal process. MAC Medicare Administrative Contractor - company contracted to administer Part A & Part B claims. Medicare Part A -hospital coverage -no premium requirements for those with 40 "work credits" of FICA or Self Employment tax credits. -Those who don't qualify can voluntarily participate by paying a monthly premium Medicare Part B The part of the Medicare program that pays for physician services, outpatient hospital services, durable medical equipment, and other services and supplies. -Has a monthly premium of $135.50 in 2019 which is deducted from SS check. -Part B enrollment is optional. You can reject Part B by signing a rejection form. Medicare Part C Medicare Advantage Plans that are offered through private insurance companies that provide both hospital and physician coverage and possible prescriptions - financed by Social Security and monthly premiums Medicare Eligibility free part A benefits -Over age 65 who have earned 40 "work credits" in order to receive premium -Permanently disabled prior to age 65 for at least 24 months -ESRD or kidney disease requiring dialysis or kidney transplant Medicare enrollment requirements Part A & B are automatically conducted by SSA when individual age 65+ enrolls for their Social Security retirement benefits Initial Enrollment Period 7 month period straddling 3 months before and ends 3 months after the individual turns 65, including the birthday month. -If enrollment is during the 3 mos prior to 65th birthday, coverage begins on 1st day of 65th birthday month -If enrollment is during or after 65th birthday month, coverage begins on 1st day of month after enrollment Medicare enrollment period - January 1st through March 31st General Enrollment Period annually. -Coverage begins July 1st of that year -Monthly premium for part B may go up 10% for each full 12 month period that you're eligible but didn't sign up. Special Enrollment Period Individual can enroll at 8 months beginning with the month employment ends or when group coverage ends whichever is earlier without subject to late enrollment surcharge Medicare as a secondary or primary payer -Medicare is the secondary payer for the 'working aged' who has a group health plan if the group has 20+ enrollees -For single employer with 20 employees with a group health plan, Medicare is the primary payer. -If individual retains coverage thru the group plan, the group contract is the primary unless person is retired & still covered under the group plan. In that case, Medicare is the primary. -If individual rejects the employer plan, Medicare is the primary payer Medicare as a secondary payer -In cases of Workers' Comp when it applies to an injury or illness - In cases where no-fault insurance or liability insurance is available as primary payer. Medicare & the VA Can choose to get treatment under either plan. Medicare usually will not pay benefits if services are rendered in a VA facility but will pay if outside of VA. There is NO coordination between Federal agencies. Expenses NOT paid by Medicare -Purely custodial care/ chronic care -Services that are not reasonable or medically necessary under Medicare standards -Services performed by relatives/ member of beneficiary's household -Services paid for by another gov't agency Medicare Part A covers -acute inpatient hospital care -inpatient skilled nursing care -medically necessary home health care & hospice services Medicare Deductible -Deductible must be met for ea. benefit period -Benefit period ends 60 days after discharge -Deductible is $1364 plus need to pay/ replace first 3 pts of blood per calendar year. Days 1 to 60 Non-Exhaustible Benefit -After deductible is met, Part A pays 100% of all approved hospital charges for first 60 days of confinement. From day 61 to 90th day of confinement 25% of current deductible ($341) per day. -Also a non-exhaustible benefit 60 day Lifetime Hospital Reserve Benefit for 90days -Exhaustible Benefit Part A will pay 100% of approved charges less a copay of Reserve days may be used after pt has been hospitalized -Will no longer be available once it's been used. -Pays 100% less a daily copay of $682 equivalent of 50% of current deductible. benefit period (Medicare) begins with the first day of hospitalization and ends when the patient has been out of the hospital for 60 consecutive days. Non-Exhaustible Benefit lifetime reserve. for each separate benefit period is 90 days with an exhaustible 60 day -Medicare no longer pays hospital expenses during that benefit period after lifetime reserves are