Beginning in 1965 Medicare became law as we know it now. Over the years it has evolved into the primary source for medical care to seniors over the age of 65. For those who are disabled, it is available under the age of 65. Those who are covered by Medicare are referred to as the Enrollee or Participant.

Once you are enrolled into Medicare, your medical care billing process will be quite different from when you were under age 65.

To use Medicare briefly; Go to your provider, present your Red, White & Blue Medicare Card and your Supplemental Insurance card. Your provider will file the claim to both Medicare and your Insurance Co. You will receive letters explaining how the bill is being taken care of. As one of our clients, call us if you should have any questions. The systems works very smoothly and efficiently

  Basics: Medicare has 4 primary parts; parts A, B & C, and as of 2006, a new 4th part, Part D.

Part A will cover hospital expenses 100%, after a deductible, of the cost of your stay.

Part B, after the deductible, covers all approved charges other than the hospital charges at 80% of the approved amount.

Part C, covers programs such as an HMO or other Medicare Advantage plans. See more information below. Under Part C, different rules and benefits may apply.

Part D was designed to assist in the cost of prescription drugs out of the hospital.

The Basic Benefits are available to those enrolled in Medicare. They will be covered later. The cost of care over and above the basic benefits is at the expense of the enrollee. There is a gap between what is charged and what Medicare pays (80%) towards the cost of care. To cover that Gap, individuals purchase a Medicare Supplement, also referred to as a Medigap policy.

The cost of a hospital stay under Part A, regardless of the total cost, is limited to the deductible. Part B, also referred to as the Doctor’s charges have no limit. Your cost of an office visit is nothing when compared to the cost of By-Pass surgery. Enrollees purchase the Medicare Supplement to cover the unlimited cost of Part B expenses.

Medicare Benefits are set by Medicare. This means that the Medicare Supplement offered by one company is no different than being offered by another. The cost will vary, but not the benefits.

At Senior Services, we have access to several companies providing coverage in the State of Florida. The differences will be if you want a Select or Non-Select type of policy. Some are better at higher ages or your location Etc. In each, we will strive to provide you the best price available. Send us the information form and we will return a proposal to you. We can either hand deliver or mail an application for your original signature.

Plan C

Under Plan C are several options to the Original Medicare coverage.  They include a Private fee for Service (PFFS) plans, HMOs etc. We do recommend a PFFS. It may save you money and will still provide you the care you expect plus other enhanced benefits. NOTE: We will not recommend any HMO. The plans are often restricted to certain counties in the state. The benefits will vary according to the type of plan and your location. Consult the following pages or the Medicare Guides for more information.

Medicare Advantage Plans

These include Private Fee for Service plans. They still follow Medicare guidelines with enhanced benefits. You will have flexibility of your Dr. choice, When and where you receive care, and more control over your expenses. Portability to travel. They quite often will have improved benefits over the original Medicare plan

We offer these plans from several companies. E-mail us at the link below or call us and we can discuss the benefits offered and their respective cost. Some will have no monthly premium.

HMOs

HMOs ( Health Maintenance Organization) have certain appeal, especially from a marketing standpoint. They many times will offer lower monthly cost upfront as an incentive for your enrollment and return your Part B premium. If you choose to enroll into a HMO, you are opting out of Medicare and are not eligible for Medicare benefits. The HMO will replace your Medicare enrollment and benefits. If you are considering an HMO, check out what they will charge you for going to the hospital, emergency room, co-insurances, portability and other costs.

In Florida, HMOs are issued for individual counties. That is why many have asked why they were not able to enroll into an HMO. If you enroll in one county, you may be restricted to care provided in that county only. If you travel out of the county or state and need care other than possible emergency care, can you receive it? If you need to enroll into a HMO for cost reasons, be sure to check out your restrictions and costs before you make a change.

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