Florida Medicare Health Insurance is available to all residents who are 65 years of age or older. United States citizens and people with residential visas that are under 65 years of age may also qualify for Florida Medicare Health Insurance. Your age is not a factor if you have certain disabilities, have End-Stage Renal Disease (ESRD), or if you are diagnosed with Amyotrophic Lateral Sclerosis (ALS). ESRD is massive kidney failure and ALS, or “Lou Gehrig’s Disease” is a condition that causes the nerve cells in the brain and spinal cord to degenerate. Florida Medicare Health Insurance is made up of several components within Medicare and may also involve supplemental health insurance policies, known as Medigap.
The Parts Of Medicare
Medicare Part A is hospital insurance that typically covers inpatient services, skilled nursing facilities, and care for the terminally ill. Long term care facilities are not included in this coverage. There is no charge for Part A provided the participant or participant’s spouse paid enough in Medicare taxes during employment. If you do not qualify for free Part A coverage you can purchase it, and if you are low income you may qualify for assistance to help pay for it.
Medicare Part B is medical insurance that covers a wide range of medically necessary services, including ambulance services, blood work, bone mass measurement, doctor’s visits, emergency room services, flu shots, glaucoma tests, hearing tests, lab work, routine screenings as well as screenings for diabetes and heart disease, and therapy. Medicare Part B coverage requires a monthly premium, and depending on your plan also includes deductibles and co-payments. The 2009 monthly premium for Medicare is $96.40 and is usually deducted right from your Social Security check. If you do not choose to elect Medicare Part B when you turn 65, you will pay an additional premium, which can be up to 10% per year for every year you did not enroll. Premiums can also increase depending on your income level. Income based premiums became effective in Florida in 2007.
Medicare Parts A and B
Parts A and Parts B of Medicare are often referred to as Original Medicare, and also oftentimes require supplemental insurance known as Medigap. Medigap is purchased from a private insurance company to help with the various expenses of medical services that are not covered by Medicare. In Florida, all Medigap plans must include co-insurance for hospital stays as well as coverage for 365 hospital days. The policy must also include 20% reimbursement for medical services that are not covered by Medicare and additionally the policy has to honor the first three pints of blood needed by a participant each year. Additional coverage can be purchased to help offset the costs of charges that exceed Part B coverage, co-insurance for skilled nursing facilities, deductibles for hospitals, overseas emergency care, preventative care, and recovery care within the home. Some policies can also provide benefits to supplement prescriptions with Medicare Part D.
Medicare Part C
Medicare Part C pertains to Medicare Advantage Plans which cover Part A and Part B, but eliminate the need for a Medigap policy. Some plans also include coverage for prescription drugs, eliminating the need for Part D. There are several options for Part C, which include a Health Maintenance Organization (HMO) and a Preferred Provider Organization (PPO). While an HMO requires referrals and network providers, a PPO allows for out of network coverage and seeing specialists does not usually necessitate a referral.
Others are offered too. A Private Fee-for-Service (PFFS) is a different kind of plan where the costs of the benefits are dictated by the insurance plan instead of Medicare, which can result in some lower costs and some higher costs depending on the benefit. The Medical Savings Account (MSA) has two parts to it. The first part involves a high deductible which varies by the plan and the second part is a Medicare deposit into the Medical Savings Account which is used to pay for medical services.
People with chronic conditions or multiple diseases who need care management can benefit from the Medicare Special Needs Plan, which combines Part A and Part B. In addition to being available for people with chronic conditions, the Medicare Special Needs Plan may also be offered to people in nursing homes or to people who qualify for both Medicare and Medicaid.
There are some additional plans that are also carried under Part C. Medicare Cost Plans are an HMO type of service plan that actually covers out-of-network services as Original Medicare. With this plan, if you go out of the network you are only responsible for the deductibles and co-insurance of Parts A and Parts B.
There is also a Demonstration/Pilot Program that is offered to certain groups in specific areas which tests various improvements made to Medicare in regards to both cost and quality of care. PACE stands for Programs of All-Inclusive Care for the Elderly and covers medical, social, and long term care needs. The premise behind PACE is to allow frail senior citizens to maintain their independence while still receiving quality care. In order to be eligible for PACE, you must be at least fifty-five years of age, live in a PACE service area, be nursing home status certified, and be able to live in the community without posing a danger to yourself or to others.
Medicare Part D
Medicare Part D applies to prescription drug coverage. There are several options to include pharmaceuticals in your health care plan under Medicare. You can add the Medicare Prescription Drug Plan to your Original Medicare, purchase the Medicare Cost Plan, buy the Medicare Private Fee for Service Plan, or enroll in a Medicare Advantage Plan that includes prescription drugs. Depending on the plan, your costs will vary on deductibles and co-insurance as well as on the type of medications you require. Participants with low income or limited resources may be eligible for financial assistance with Medicare Part D.
Getting Started With Medicare
Open enrollment for Medicare is January 1st through March 31st. Annual enrollment is November 15th through December 31st. If you have not already enrolled in Medicare, you can start the process by reviewing Original Medicare and then consider your various options.
If you decide to enroll for Original Medicare, it is a good idea to supplement the plan with a Medigap policy from a private insurance company; and if you plan on international travel, you may want to purchase travel insurance. While some people may consider travel insurance unnecessary, others recommend it due to the increased health risks and related emergencies that can be associated with the elderly.
The Medicare Prescription Drug Plan also needs to be regarded as part of your overall health management insurance. It may be beneficial to purchase a Medicare Advantage Plan that covers medical, hospital, and prescription drugs, eliminating the need for various policies. Some Medicare Advantage Plans include eye exams, dental needs, hearing aids, and even overseas emergency health care.
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Expenses for health care plans vary, and when considering various components of insurance coverage costs, you need to factor in premiums, deductibles, and coinsurance. In addition to benefits covered, you must think about the costs of services that you may need that are not covered Comparing the costs of your associated needs will aid you in choosing the right insurance coverage. By calling the phone number above your questions can be answered by an independent FL health insurance agent. Or, you can start comparing FL health insurance quotes right away by entering your zip code above.