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With No Riders
This is the least expensive but also offers the least
coverage.
Does Not Cover:
• The $992 Part A
hospital deductible.
• The $110 Part B annual deductible.
• Prescription drugs.
• Non-emergency medical care outside of the United
States (with some exceptions for Mexico and Canada)
Does Cover:
• All Part A
co-insurance amounts and 100% of all eligible expenses
for hospitalization not covered by Medicare (except
the $912 part A hospital deductible).
• The Part A $114 co-payment for skilled nursing
facility care, up to the 100th day.
• The Part A blood deductible of three pints.
• The Part B 20% co-payments.
• 100% of the costs of immunization and a routine
cancer screening
• 80% of emergency foreign travel care.
• 50% of the approved amount for most outpatient
mental health services.
PER PERSON MONTHLY COST
RANGE:
$74 - $168
Basic Supplement with Riders
To cover the gaps in the Basic Medicare Supplement, the
State of Minnesota allows the insurance company to offer
the following additional coverage (riders) for added
cost:
RIDER 1 covers the $912 Part A hospital
deductible (per-person monthly cost range for Rider 1
only: $19.42-$53.58).
RIDER 2 covers the $110 Part B annual
deductible (per-person monthly cost range for Rider 2
only: $7.92-$9.17).
RIDER 3 covers the difference between
the Medicare approved amount and the medical bill.
Minnesota requires in-state providers (except ambulance
services and medical supplies and equipment) to accept
the Medicare approved amount, so this rider may not be
needed unless you are outside of the state. Rider 3 has
two options: either 100% coverage or 80% coverage of the
difference. (Per person monthly cost range for Rider 3:
80% - $3.42-$10.08; 100% - $3-$36).
RIDER 4 for at least 50% coverage for
prescription drugs. No companies offer this rider in
Minnesota.
RIDER 5 covers up to $120 per year for
physicals, hearing tests, cholesterol and diabetes
screening, and thyroid function tests (per person
monthly cost range for Rider 5 only: $3.58-$16.33).
RIDER 6 covers up to $1,600 per year
for short term, at-home assistance with activities of
daily living, such as bathing, dressing, and personal
hygiene. In order for this rider to apply, Medicare must
cover skilled home care first (per person cost range for
rider 6 only: $4-$23.17).
Medicare Supplements ("Medigap" policies) (Basic and
Extended Basic)
Minnesota allows the sale by private insurance companies
of two types of supplement policies (often called "Medigap"):
Basic (optional riders may be added) and Extended Basic,
which help cover some of the costs Medicare doesn't
cover. Extended Basic offers the most comprehensive
coverage, including 80% coverage of prescription drug
costs. Note: In many other states, ten policy options, A
through J, are available. Nevertheless, Minnesota’s
policies equal or exceed national standards. Medigap
policies do not require you to receive services from a
specified network of providers, but more paperwork may
be needed.
Note: When shopping for a Basic or
Extended Basic policy, you need only compare costs and
the reliability of the insurance company. Minimum
benefit levels are mandated by Minnesota law and do not
differ among companies, although some companies may
elect to offer higher benefit levels of certain
state-mandated coverage. Call the company to ask about
coverage of non-standard items.
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These can be the most expensive policies of all
supplement options.
In addition to the coverage offered by the
Basic Plan
with all the riders, the Extended Basic policies offer
the following coverage:
· 80% of usual and customary fees not paid by Medicare,
including foreign travel.
· 80% payment of prescription drugs. Note: This coverage
can no longer be purchased as of January 1, 2006, but if
you purchase it before that date, you may keep it
indefinitely.
· 100% of the cost of immunization and routine cancer
screening.
· 50% approved amount of most outpatient mental health
services.
· $1,000 annual limit on any money you pay out of your
own pocket on covered medical expenses. Once you have
reached this limit, the policy will pay 100% for all
covered expenses including drugs
PER-PERSON MONTHLY
COST RANGE: $422 to $915.
Medicare Supplement (Basic and Extended Basic)
Minnesota allows the sale by private insurance companies
of two types of supplement policies (often called "Medigap"):
Basic (optional riders may be added) and Extended Basic,
which help cover some of the costs Medicare doesn't
cover. Extended Basic offers the most comprehensive
coverage, including 80% coverage of prescription drug
costs. Note: In many other states, ten policy options, A
through J, are available. Nevertheless, Minnesota’s
policies equal or exceed national standards. Medigap
policies do not require you to receive services from a
specified network of providers, but more paperwork may
be needed.
Note: When shopping for a Basic or
Extended Basic policy, you need only compare costs and
the reliability of the insurance company. Minimum
benefit levels are mandated by Minnesota law and do not
differ among companies, although some companies may
elect to offer higher benefit levels of certain
state-mandated coverage. Call the company to ask about
coverage of non-standard items.
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These
are a cross between a Basic Medicare Supplement with
some riders, and a Health Maintenance Organization
(HMO), since the plans include some preventative care
and minimum or no paperwork. To receive the most
coverage, there may be a requirement to use the network
of health care providers within a service area.
a. Covers 100% of the $912 Part A hospital deductible as
long as you use the providers stipulated in the plan.
b. Covers 100% of the $110 annual Part B deductible as
long as you use the providers stipulated in the plan.
c. Covers 100% of physician charges as long as you use
the providers stipulated in the plan.
d. Offers options, at higher premiums, to obtain either
50% or 80% prescription drug coverage.
e. If out-of-network providers are used in a
non-emergency, Medicare will pay their portion of the
approved charges, but most Medicare Select Plans will
probably not pay anything. Check with the individual
company.
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To
receive the most coverage, Medicare Cost Plans require
you to receive your care through a network of health
care providers.
a. Cost plans are HMOs, but they do not “lock” your
Medicare coverage into the HMO, as do the Medicare
Advantage plans. To get the most coverage from the Cost
plan you must use providers in the plan’s network
b. Covers 100% of the $912 Part A hospital deductible as
long as you use the network of providers, but some plans
may require a co-pay.
c. Covers 100% of the $110 annual Part B deductible as
long as you use the network.
d. Covers 100% of physician charges as long as you use
the network of providers, but some plans may require a
co-pay.
e. Offers options or riders, at higher premiums to
obtain various levels of prescription drug coverage.
f. Some plans may offer a Medicare-approved drug
discount card to help you save on your outpatient
prescription drug costs. There may be an enrollment fee
of up to $30 per year.
g. If out-of-network providers are used in a
non-emergency, Medicare will pay their portion of the
approved charges, but the Medicare Cost plan will
probably not pay anything (unless your plan offers an
Extended Absence Option. Contact plan for more
information).
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Note: If you are eligible for coverage through
your former employer, benefits and rates may be
different than those listed here.
Medicare Advantage Plans "lock in" your Medicare
coverage to the plan. You sign your Medicare benefits
over to the plan and agree to receive all of your health
care through the plan. The only payer of any of your
health care bills can be the Medicare Advantage plan,
not Medicare. To receive payment for Medicare services,
you must use the plan's network of providers. The
Medicare Advantage Plan should cover out-of-network
emergency care.
a. Covers 100% of the $912 Part A hospital deductible as
long as you use network of providers, but some plans may
require a co-pay.
b. Covers 100% of the $110 annual Part B deductible as
long as you use network of providers.
c. Covers 100% of physician charges as long as you use
network of providers, but some plans may require a
co-pay.
d. These plans offer a Medicare-approved drug discount
card to help you save on your out-patient prescription
drug costs.
e. If out-of-network providers are used in a
non-emergency, and a point of service option is not part
of the plan, you will probably be responsible for all
charges. Some plans do have a travel benefit, which
allows for some out-of-network services.
f. Medicare Advantage Plans cannot health screen at any
time. If diagnosed with End Stage Renal Disease (ESRD),
check with your health plan.
g. Beneficiaries typically can enroll and disenroll from
Medicare Advantage plans at any time. The annual
election period in 2005 is extended and will run from
Nov. 15, 2005 to May 15, 2006.
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5b)
Medicare Advantage Private
Fee-For-Service Plans
(sold by four companies: Medica, Sterling Life Insurance
Company, Humana Insurance Company and UniCare Life and
Health Insurance Company)
A Private Fee-For-Service (PFFS) plan is a Medicare
Advantage Plan offered by a private insurance company.
Medicare pays a set amount of money monthly to the
insurance company to provide health care coverage to
enrollees on a pay-per-visit arrangement. Although costs
for services may not be the same as original Medicare,
you get all services covered under Medicare Parts A and
B. The plan may also offer additional benefits.
Monthly premiums vary by company and you must be told
what premiums will be for the coming year before
enrolling. You must continue to pay your Medicare Part B
premiums in addition to the PFFS premium.
PFFS plans reimburse doctors and hospitals based on
Medicare-approved amounts under original Medicare.
Beneficiaries may have out-of-pocket costs including
co-insurance, co-pays and deductibles, but these may not
exceed the actuarial equivalent of the "average amount"
you would pay for original Medicare fee-for-service. In
addition:
a. You are not restricted to a provider network
b. A PFFS may be attractive in rural areas where there
are few health plan choices
c. PFFS plans are required to pay only for medically
necessary services that are covered by the plan.
d. Enrollees may obtain care from any licensed physician
or provider in the U.S. who can be paid by Medicare and
who accepts the plan's terms of payment. Provider
participation is entirely voluntary.
e. Enrollees cannot be balance-billed by providers
(unless permitted by the plan).
f. Enrollees typically can enroll and disenroll at any
time.
Information in
this guide is intended only to help you compare
different health plans. For specific coverage, rates and
terms of any plan, contact the company that sells it or
the Minnesota Department of Commerce.
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Minnesota Senior Federation Metropolitan Region
1885 University Ave W Ste 190,
Saint Paul, MN 55104
Phone: 651-645-0261
From Greater Minnesota: 1-877-645-0261,
Fax: 651-641-8969
Email:
Info@mnseniors.org
http://mnseniors.org/content/view/73/64/#1 |
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