What’s the difference between Term Life Insurance and Whole Life Insurance?
What is funeral, burial, or final expense insurance?
I am single. Do I need life insurance?
Why do I need Hospital Indemnity coverage?
How Is Cancer Insurance different from traditional major medical insurance?
Who is eligible for Medicare?
What is the difference between Medicaid and Medicare?
What is a Medicare Advantage Plan (Part C)?
What is Medicare Part D?
How do I pay for Traditional (Part A and Part B) Medicare?
How do I pay for Medicare Advantage?
How do I pay for a supplemental insurance?
What if I have the Original Medicare Plan (Medicare Part A and Part B) and I don’t have prescription drug coverage?
When and how often can I switch my Medicare drug plan?
If I am not certain whether or not I qualify, should I apply for extra help?
What does Medicare Part A Cover?
What services are NOT covered by Medicare Part A?
What does Medicare Part B cover?
What preventive services are covered by Medicare Part B?
What medical supplies and equipment does Medicare Part B cover?
Does the Original Medicare Plan cover mental health care?
What does “medically necessary” mean?
Will Medicare pay for ambulance services from home to the doctor’s office?
How do I get a replacement Medicare card if my card is lost, stolen, or damaged?
If I retire at age 62 will I be eligible for Medicare at that time?
Can I get Medicare if I am under age 65?
Do I really need a prescription drug plan?
Does a prescription drug plan make sense for someone who takes only a few prescriptions each month?
What is a drug formulary?

What’s the difference between Term Life Insurance and Whole Life Insurance?

All life insurance falls into two broad categories Term Life or Whole Life. Both require you to pay a premium and both provide the lump sum amount upon the death of the insured person. While they are similar they also have distinct differences. The primary difference is that Term Life has a policy expiration date and Whole Life does not. The benefit of Term Life is that it is less expensive for the duration of the police term. Because Term Life expires and must be renewed, it becomes more expensive as you purchase a new policy to continue your coverage. A person must also be healthy when they renew a Term Life insurance policy. Whole Life has no expiration date but is more expensive in the first few years of coverage. A benefit of Whole Life is that it can never be cancelled due to age or illness

What is funeral, burial, or final expense insurance?

These are normally different names for Whole Life insurance. These names normally imply they are for smaller death benefit amounts of Whole Life insurance policies. Many people choose to purchase these policies to help pay for the expenses that occur at the time of your death. Final expenses include the cost of a funeral and items related to the funeral such as transportation, lodging for relatives, religious services, reception, and other similar costs.

I am single. Do I need life insurance?

Single people often don’t think about life insurance, and in some cases, they are right. However, there are many factors that determine your need for life insurance, and the fact is marital status is just one. What you need to consider is if you died tomorrow, would you leave enough to cover your funeral expenses? If not, who would be responsible for paying? Are you willing to leave that cost up to them? For many families, a relatively simple funeral (average cost is $6,500) can create a major financial burden at an already stressful time. For this reason alone, you might consider purchasing a simple burial policy.

Why do I need Hospital Indemnity coverage?

Because hospital stays are expensive and health insurance doesn’t pay for everything. Hospital care can be very expensive and can easily wipe out your savings. If excessive care is needed, the cost may bankrupt you.

  • The average expense of an inpatient hospital stay per person is $13,033.
  • More than 1 in 3 persons will be treated in a hospital.
  • 45.2% of health care spending is associated with hospital treatment.

How Is Cancer Insurance different from traditional major medical insurance?

Health insurance pays or reimburses the amount charged to the insured by a hospital, or physician, procedures, for medical services, medical goods, some treatment and most prescription drugs covered by each person’s specific plan. A Cancer Plan pays an immediate one-time, lump-sum payment directly to the insured upon initial diagnosis of a covered cancer. The money can be used for any purpose you choose such as covering deductibles, clinical trials or experimental treatments, home health care, loss of income, covering expenses while recuperating, etc.

Frequently Asked Questions about Medicare

 

Who is eligible for Medicare?

Medicare is offered to people age 65 or older, younger people with disabilities and people with End Stage Renal Disease (kidney failure requiring dialysis or transplant). Medicare has two parts, Part A and Part B. To be eligible for premium-free Part A you need to be age 65 or older and either you or your spouse worked and paid Medicare taxes for at least 10 years. You are eligible for Part A at age 65 without having to pay premiums if:

  • You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.
  • You are eligible to receive benefits from Social Security or the Railroad Retirement Board but you have not yet filed for them.
  • You or your spouse were employed by the government and covered by Medicare.

If you (or your spouse) did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A.

If you are under age 65, you may receive Part A without paying a premium if:

  • You have been qualified to receive Social Security or Railroad Retirement Board disability benefits for 24 months. (Note: If you have Lou Gehrig’s disease, your Medicare benefits begin the first month you get disability benefits.)
  • You receive kidney dialysis or have received a kidney transplant.

While most people don’t pay for Part A, everyone must pay for Part B. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these checks, Medicare will bill you personally for your Part B premium every 3 months.

What is the difference between Medicaid and Medicare?

Although Medicaid and Medicare have similar names, they are in fact very different programs. One of the major differences is Medicaid is managed at a state level and Medicare is managed at a federal level. Here are some other differences:
Medicaid is for LOW INCOME:

  • Women who are pregnant
  • Children (under age 19)
  • People over age 65
  • People who are blind
  • People who are disabled
  • People who need nursing home care

Medicare is for:

  • People over age 65
  • People who have kidney failure or long term kidney disease
  • People who are permanently disabled and due to their disability cannot work

Some people qualify for both Medicaid and Medicare, Medicaid is sometimes used to help pay for Medicare premiums. People who qualify for both programs are called ‘dually eligible’.

What is a Medicare Advantage Plan (Part C)?

A Medicare Advantage Plan (like an HMO or PPO) is a Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.

To join a Medicare Advantage plan, you must have Medicare Part A AND Part B. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and wellness programs. Most include Medicare prescription drug coverage (Part D).

Medicare pays for the management of your care every month to the companies offering Medicare Advantage Plans. These companies follow strict rules set by Medicare. However, each Medicare Advantage Plan charges different out-of-pocket costs and have different rules for how you go about getting services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for nonemergency or non-urgent care). These rules can change each year.

What is Medicare Part D?

Part D was created under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (2003 Medicare Act) to help cover the costs of prescription drugs. Prescription drug coverage is offered only by private companies contracted with Medicare through stand-alone plans (for beneficiaries who have Original Medicare) and through HMOs, PPOs, and PFFSs (for beneficiaries who have a Medicare Advantage plan). Anyone who has Original Medicare or Medicare Advantage is eligible to enroll in Part D. Enrollment in Part D is voluntary. To join a Medicare Prescription Drug Plan, you must have Medicare Part A OR Part B.

All the different companies have drugs they cover and do not cover. It is important to make sure the Medicare Part D coverage drug plan you choose covers each and every medication you take. Many people want to choose a cheap prescription plan, but do not check to see if the actual medications they take are covered.

How do I pay for Traditional (Part A and Part B) Medicare?

You usually don’t have to pay a premium every month for Medicare Part A. This is true if you or your spouse paid enough Medicare taxes while working. If this is not the case, you CAN buy Part A.

Most people must pay monthly for coverage under Medicare Part B. If you are eligible for Part B and do not join, the monthly cost of Part B may go up 10% for each full 12-month period that you are eligible but do not sign up.

How do I pay for Medicare Advantage?

Each month, Medicare pays money to your advantage plan to provide your care. The advantage plan is then responsible for paying your doctor, hospital, and other providers of care.

Your advantage plan must follow Medicare’s rules, and it can charge you a premium and additional out-of-pocket expenses, such as a co-payment for a doctor visit, co-insurance for durable medical equipment, and an annual deductible for prescription medications.

You also are responsible for your Medicare Part B monthly premium, which is taken out of your social security check.

How do I pay for a supplemental insurance?

In addition to the monthly Medicare Part B premium to Medicare, you pay a premium to the insurance company that provides your coverage. There are several ways to pay, including automatic bank account withdrawal or credit card. You also have the option of a coupon book. Choosing automatic bank withdrawal or credit card as your payment method often results in discount to your monthly plan premium.

What if I have the Original Medicare Plan (Medicare Part A and Part B) and I don’t have prescription drug coverage?

If you want Medicare to help pay for your drugs, you must join a plan that provides Medicare prescription drug coverage. We can help you choose and join the plan that meets your needs. Even if you don’t use a lot of prescription drugs now, you should still consider joining. The fact is that as we age, most people need prescription drugs to maintain their health. In most cases, joining when you are first eligible for Medicare means no penalties if you change your mind and choose to join at a later date. Your premium will be higher if you wait because of this penalty.

You will be given the chance to join a drug plan when you are first eligible for Medicare. In most cases, if you choose not to join one at that time, your next chance to join will be between November 15th and December 31st each year, and you will be charged a penalty. That means you pay a higher monthly premium the duration of your Medicare prescription drug coverage.

When and how often can I switch my Medicare drug plan?

Generally speaking, there are only certain circumstances that allow you to change your plan once you join a Medicare Prescription Drug Plan. You can choose to switch your current plan from October 15 through December 7 of every year.

In certain cases, such as if you move or enter a nursing home, you can switch your plan at other times. Contact us if you would like more information on your specific circumstances.

If you have both Medicare and Medicaid, you can change plans at any time.

If I am not certain whether or not I qualify, should I apply for extra help?

Yes, because there is no risk or cost to apply. And, if you qualify, you will get extra help paying for the annual deductible, premiums, and copayments for Medicare prescription drug coverage.

What does Medicare Part A Cover?

Medicare Part A helps pay for care in the following facilities if they are deemed medically necessary by Medicare.

  • Inpatient hospital care (including critical access hospitals)
  • Skilled nursing facilities (SNFs)
  • Long Term Care Hospital (LTCH)
  • Inpatient Rehabilitation Facility (IRF)
  • Hospice care
  • Home health care
  • Beneficiary access to religious nonmedical health care institution (RNHCI) services
  • Inpatient Mental health/psychiatric care
  • Obesity Bariatric Surgery

Medicare Part A helps pay for the following services if they are deemed medically necessary by Medicare.

  • Anesthesia
  • Chemotherapy
  • Room and Board
  • All meals and special diets
  • General nursing
  • Medical social services
  • Physical, occupational, and speech-language therapy
  • Drugs with the exception of some self-administered drugs
  • Blood transfusions
  • Other diagnostic and therapeutic items and services
  • Medical supplies and use of equipment
  • Respite care in hospice
  • Transportation services
  • Inpatient alcohol or substance abuse treatment
  • Part A blood (see the restrictions under services NOT covered)
  • Clinical Trials (Inpatient)
  • Kidney Dialysis (Inpatient)

What services are NOT covered by Medicare Part A?

Part A Non-Covered Services
Medicare Part A DOES NOT cover the following:

  • Private duty nursing
  • A television or telephone in your room or personal care items like razors or slipper socks
  • A private room (unless medically necessary)
  • Custodial care, assisted living, adult daycare, or reimbursement for family members
  • The first three pints of blood unless the blood deductible has been met

The doctor services you get while you are in a hospital may be filed under Part B.

What does Medicare Part B cover?

Outpatient care is usually covered under Medicare Part B. Medicare Part B covers 80 percent of medically necessary physician or outpatient charges, including charges from a physician for care received in a hospital.

Services covered under Medicare Part B include:

  • Ambulance Services
  • Ambulatory Surgical Centers
  • Blood (the first 3 units of blood are not covered unless you have the blood donated by you or someone else)
  • Cardiac Rehabilitation
  • Chiropractic Services (limited)
  • Clinical Laboratory Services
  • Clinical Research Studies
  • Defibrillator (Implantable Automatic)
  • Diabetes Supplies (note: insulin and certain medical supplies used to inject insulin, such as syringes, and some oral diabetic drugs may be covered by Medicare Prescription Drug coverage, Part D)
  • Doctor Services
  • Durable Medical Equipment (like walkers)
  • EKG Screening
  • Emergency Department Services
  • Eyeglasses (one pair of eyeglasses with standard frames or one set of contact lenses after cataract surgery that implants an intraocular lens)
  • Federally-Qualified Health Center Services
  • Foot Exams and Treatment (only if you have diabetes-related nerve damage and/or meet certain conditions)
  • Hearing and Balance Exams (only if your doctor orders these tests to see if you need medical treatment; also hearing aids and exams for fitting hearing aids are not covered)
  • Home Health Services (covers only medically necessary services)
  • Kidney Dialysis Services and Supplies
  • Kidney Disease Education Services
  • Mental Health Care (you pay 20% of the Medicare-approved amount for a visit to a doctor or other health care provider to diagnose your condition; you pay 45% for treatment of your condition)
  • Non-doctor Services (such as physician assistants, nurse practitioners, social workers, physical therapists, and psychologists)
  • Occupational Therapy
  • Outpatient Medical and Surgical Services and Supplies
  • Physical Therapy (there may be limits or exceptions on these services)
  • Prescription Drugs (limited to medications such as injections you get in a doctor’s office, certain oral cancer drugs, drugs used with some types of durable medical equipment, such as a nebulizer or external infusion pump)
  • Prosthetic/Orthotic Items
  • Pulmonary Rehabilitation
  • Rural Health Clinic Services
  • Second Surgical Opinions (in some cases, Medicare covers third surgical opinions)
  • Smoking Cessation (not part of the new preventive care services)
  • Speech-Language Pathology Services
  • Surgical Dressing Services
  • Tele-health
  • Tests (other than lab tests, such as x-rays, MRIs, CT scans, EKGs, and some other diagnostic tests)
  • Transplants and Immunosuppressive Drugs
  • Travel (health care needed when traveling outside the U.S. — rare cases such as in an emergency and a foreign hospital is closer than a U.S. hospital)
  • Urgently-Needed Care

What preventive services are covered by Medicare Part B?

Medicare Part B covers the following types of preventive health services:

  • Physical Exam
  • Cardiovascular Screening
  • Cancer
  • Breast Cancer Screening (Mammograms)
  • Cervical and Vaginal Cancer Screening (Pap Test and Pelvic Exam)
  • Colon Cancer Screening (Colorectal)
  • Prostate Cancer Screening (PSA)
  • Shots
  • Flu Information
  • Pneumococcal Shot
  • Hepatitis B Shots
  • Bone Mass Measurements
  • Diabetes Screening, Supplies, and Self-Management Training
  • Glaucoma Tests
  • Medical Nutrition Therapy
  • Abdominal Aortic Aneurysm (AAA) Screening

What medical supplies and equipment does Medicare Part B cover?

Medicare Part B will help pay for durable medical equipment such as oxygen equipment, wheelchairs, walkers, and other equipment that your doctor prescribes. Some equipment must be rented, other equipment must be purchased.
Other items covered by Medicare include:

  • arm, leg, back and neck braces
  • medical supplies such as ostomy bags, surgical dressings, splints and casts
  • breast prostheses due to a mastectomy
  • one pair of eyeglasses with an intraocular lens after receiving cataract surgery

Does the Original Medicare Plan cover mental health care?

Medicare Part A covers mental health care given in a hospital, including room, board, nurse care, and other services and supplies. Medicare Part B covers outpatient mental health services, including visits with a doctor, clinical psychologist, clinical social worker, and lab tests.

What does “medically necessary” mean?

Services or supplies are considered medically necessary by Medicare if they:

  • Are needed for diagnosis, or treatment of your medical condition.
  • Meet the standards of good medical practice in the medical community of your area.
  • Are not solely for the convenience of you or your doctor.

Will Medicare pay for ambulance services from home to the doctor’s office?

No, Medicare will not cover an ambulance transport to the doctor’s office.

How do I get a replacement Medicare card if my card is lost, stolen, or damaged?

If your Medicare card is lost, stolen or damaged, you can ask for a new one via the Social Security Administration website. Your red, white and blue card will be mailed within 30 days to the address SSA has on file for you. If you need proof that you have Medicare sooner than 30 days, you also can request a letter which you will receive in about 10 days. If you need proof immediately for your doctor or for a prescription, visit your nearest Social Security office.

If you have moved and have not reported this information to SSA, you will need to report the address change before they can process your request for a replacement card. If you have moved and have reported this information to SSA, you will need to contact them before they can process your request.

If you prefer, or if you are unable to use the online request to obtain a replacement Medicare card, call Social Security’s toll-free number, 1-800-772-1213. Their representatives there will be glad to help you. You can also visit your local Social Security office.

If I retire at age 62 will I be eligible for Medicare at that time?

No. Medicare benefits do not begin until a person is age 65. If you retire at age 62, you may be able to receive medical insurance coverage through your employer. If not, you have the option to purchase coverage from a private insurance company until you turn age 65 and become eligible for Medicare.

Can I get Medicare if I am under age 65?

People under the age of 65 and who are disabled, and have been entitled to disability benefits under Social Security or the Railroad Retirement Board for 24 months, will be automatically entitled to Medicare Part A and Part B beginning the 25th month of disability benefit entitlement. You do not need to do anything to enroll in Medicare. Your Medicare card will be mailed to you about 3 months before your Medicare entitlement date.

You may refuse Part B coverage. However, if you decide to pick up Part B coverage at a later date, but before you turn 65, you may have to pay a 10% surcharge in addition to the Part B premium. Also, you should be aware that you will automatically re-enrolled in Part B when you turn 65, even if you have previously refused Part B coverage. You may refuse coverage again, but if you keep it you will not be charged a surcharge.

Note: A Special Enrollment Period is available if you waited to enroll in Medicare Part B because you or your spouse were working AND had group health coverage through an employer or union. If this applies, you can sign up for Medicare Part B:

  • While you are still covered by an employer or union group health plan, through your or your spouse’s employment, or
  • During the 8 months following the month when the employer or union group health plan coverage ends or when the employment ends (whichever comes first).

Do I really need a prescription drug plan?

The answer depends on your medical and financial situation. As one gets older the answer almost always is yes. Keep in mind the costs of prescriptions are high and expected to increase. A prescription drug plan helps to control these expenses. Remember, if you are eligible to join Medicare Part D and do not do so, you may have to pay a penalty to join the plan later.

Does a prescription drug plan make sense for someone who takes only a few prescriptions each month?

Most people with Medicare will come to need, or currently need, prescription drugs to stay healthy. So, even if you don’t need many prescription drugs now, choosing a prescription drug plan today can protect you from high out-of-pocket costs later. Also, if you don’t sign up for drug coverage when you’re first eligible but decide to enroll later, you may have to pay more each month – at least 1 percent more for every month you wait.

What is a drug formulary?

A formulary is a list of prescription medications approved for coverage by a health plan.