Medicare

Here is information and facts on Medicare,  Medicare Supplements and Medicare Advantage Plans. The Advantage Plans from Lovelace Health and the Medicare Supplement Plans from Blue Cross Blue Shield of New Mexico are at the bottom of this section.

If you have any questions or need immediate help with your Medicare, Medicare Supplement or any Advantage Plan please e-mail us at info@healthinsurancenewmexico.com or call us at 575-751-3591. Open enrollment for Medicare starts October 15, 2013.

 
When can I sign up for Medicare Part A & Part B?

When you're first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B.

Example: For example, if you're eligible when you turn 65, you can sign up during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. Call us to find out when you're eligible for Medicare.

Between January 1–March 31 each year: If you didn't sign up for Part A and/or Part B when you were first eligible, you can sign up during the General Enrollment Period between January 1–March 31 each year. Your coverage will start July 1. You may have to pay a higher premium for late enrollment.

Note: The Health Insurance Marketplace Open Enrollment period (October 1, 2013–March 31, 2014) overlaps with the Medicare Open Enrollment period (October 15–December 7, 2013).

Special circumstances (Special Enrollment Periods): If you're covered under a group health plan based on current employment, you have a Special Enrollment Period to sign up for Part A and/or Part B any time as long as you or your spouse (or family member if you're disabled) is working, and you're covered by a group health plan through the employer or union based on that work.

You also have an 8-month Special Enrollment Period to sign up for Part A and/or Part B that starts the month after the employment ends or the group health plan insurance based on current employment ends, whichever happens first.
Usually, you don't pay a late enrollment penalty if you sign up during a Special Enrollment Period.

Note: COBRA and retiree health plans aren't considered coverage based on current employment. You're not eligible for a Special Enrollment Period when that coverage ends. This Special Enrollment Period also doesn't apply to people with End-Stage Renal Disease (ESRD).
You may also qualify for a Special Enrollment Period for Part A and Part B if you're a volunteer, serving in a foreign country
 
 
What does Medicare Part A cover?

Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessary to treat a disease or condition.

If you're in a Medicare Advantage Plan or other Medicare plan, you may have different rules, but your plan must give you at least the same coverage as Original Medicare. Some services may only be covered in certain settings or for patients with certain conditions.

In general, Part A covers: 

  • Hospital care
  • Skilled nursing facility care
  • Nursing home care (as long as custodial care isn't the only care you need)
  • Hospice
  • Home health services

  • Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
  • Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.


What does Medicare Part B cover?
  • Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
  • Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.  
Part B covers things like:
  • Clinical research
  • Ambulance services
  • Durable medical equipment (DME)
  • Mental health
    • Inpatient
    • Outpatient
    • Partial hospitalization
  • Getting a second opinion before surgery
  • Limited outpatient prescription drugs

To find out if Medicare covers what you need: Talk to your doctor or other health care provider about why you need certain services or supplies, and ask if Medicare will cover them. If you need something that's usually covered and your provider thinks that Medicare won't cover it in your situation, you'll have to read and sign a notice saying that you may have to pay for the item, service, or supply.

Medicare coverage is based on 3 main factors
  1. Federal and state laws.
  2. National coverage decisions made by Medicare about whether something is covered.
  3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.

What's Medicare supplement (Medigap) insurance?

A Medicare supplement (Medigap) insurance, sold by private companies, can help pay some of the health care costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles.

Some Medigap policies also offer coverage for services that Original Medicare doesn't cover, like medical care when you travel outside the U.S.  If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.

A Medigap policy is different from a Medicare Advantage Plan.  Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.

8 things to know about Medigap policies 
  1. You must have Medicare Part A and Part B.
  2. If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can leave the Medicare Advantage Plan before your Medigap policy begins.
  3. You pay the private insurance company a monthly premium for your Medigap policy in addition to the monthly Part B premium that you pay to Medicare.
  4. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.
  5. You can buy a Medigap policy from any insurance company that's licensed in your state to sell one.
  6. Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can't cancel your Medigap policy as long as you pay the premium.
  7. Some Medigap policies sold in the past cover prescription drugs, but Medigap policies sold after January 1, 2006 aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
  8. It's illegal for anyone to sell you a Medigap policy if you have a Medicare Medical Savings Account (MSA) Plan.
Medigap policies don't cover everything: Medigap policies generally don't cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

Insurance plans that aren't Medigap: Some types of insurance aren't Medigap plans, they include:
  • Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan)
  • Medicare Prescription Drug Plans
  • Medicaid
  • Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)
  • TRICARE
  • Veterans' benefits
  • Long-term care insurance policies
  • Indian Health Service, Tribal, and Urban Indian Health plans

  What is a Medicare Advantage Plan?

Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You'll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare. Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.


LOVELACE HEALTH SYSTEMS MEDICARE ADVANTAGE PLANS

Lovelace Standard HMO Plan:
  • Zero Premium
  • Zero Deductible
  • $5,000 Maximum Out of Pocket Expense

Lovelace Enhanced HMO-POS plan:

  • $89 Premium
  • Zero Deductible
  • $1,625 Maximum Out of Pocket Expense
  Lovelace Deluxe HMO Plan with Buy Down:
  • Zero Premium
  • Part B Buy Down (Toward Part B Premium) $68 refund each month
  • $310 Deductible
  • $6,700 Maximum Out of Pocket Expense

Value added benefits:

  • Silver Sneakers Fitness Program
  • Assist America
  • Non-Emergent Transportation
  • Philips Lifeline Alert System

BLUE CROSS BLUE SHIELD MEDICARE SUPPLEMENT PLANS

Monthly premiums are based on age categories and by Male and Female participants. Below are basic components of each plan but you must call us or e-mail us for specific information and monthly premium on each plan.

Plan A: You pay the Medicare Part A and B deductibles plus up to $148 a day for Skilled Nursing for the 21st through 100th day.
Plan B: You pay Medicare Part B deductibles plus up to $148 a day for Skilled Nursing for the 21st through the 100th day.
Plan F: You pay Zero for supplement payments for Medicare parts A and B.
High Deductible Plan F: After you pay $2,110 Deductible plan pays all supplement  payments for Medicare parts A and B.
Plan N: You pay Part B deductibles plus up to $20 per office visit and up to $50 per emergency room visit.


There are many other components to these plans that will be reviewed with you individually when enrolling and filling out the application. Please e-mail us at info@healthinsurancenewmexico.com or call us at 575-751-3591 with any questions or to start the enrollment application process.