Originial Medicare
What are the three parts of Original Medicare?
Part A
Part B
Part D
Where should someone go to enroll in Medicare?
Social Security Administartion online or their local office.
Can an individual on Medicare due to disability enroll in a Medicare Supplement plan?
No.
**The offered plans are SUBPAR in every way if offered at all**
Who monitors and sets the Part D rates?
(CMS) Centers for Medicare & Medicaid.
Medicare Advantage is also know as:
Part C
What makes someone eligible for Medicare?
Their age of 65 or over or those with certain disabilities.
How many quarters does an individual have to work to qualify for premium free Part A?
40 quarters contribution to Social Security
A Medicare Advantage Plan beneficiary enrolls in a Part D Stand-Alone Drug Plan, what happens to the Advantage plan?
The participant will be automatically disenrolled from the MAPD plan and go back to Original Medicare parts A & B.
Can Part C be deducted from an individual's Social Security?
Yes. The part B premium is then paid to the Private Insurance Company instead of Federal Medicare.
If an individual purchases a Medicare Advantage Plan from VNS Health NY, they will receive Part D from where?
VNS Health. Part D is included in ALL plans for 2023.
When should someone enroll in Medicare?
3 months prior to their 65th birthday, the month of their birthday, or 3 months after their birthday.
Is there a deductible for Part A? Part B?
Yes.
Part A- $1,600
Part B- $226.00
A Med-Supp is the same as an Advantage Plan?
False. A Med-Supp works WITH Medicare as a Secondary, unlike Advantage plans that "replace" Original Medicare.
On original Medicare, a recipient could have up to 3 different medical cards. How many Medical cards should a beneficiary have with a Medicare Advantage Plan (MA-MAPD)
One card under the company in which they purchased the policy. This includes the Hospital (A) doctor (B) as well as part (D)
Note: *Flex spend cards and OTC surplus cards are not factored in.
What is the Annual Election Period?
October 15 - December 7
Does basic Medicare have a premium? If so what is it?
Part A can be premium-free if eligible (worked 40 quarters).
Part B has a premium that is standard $164.90
High-income earners will have an adjusted part B.
Where can I locate providers that accept VNS Health NY?
Provider directories can be found by visiting VNShealthplans.org
Who is eligible for Plan F?
Individuals who turn 65 prior to January 1, 2020.
What is the maximum deductible allowed for the Part D/PDP plan as set by Medicare?
$505.00
What are the three most common types of Medicare Advantage Plans?
Health Maintenance Organizations (HMOs)
Preferred Provider Organizations (PPOs)
Private Free-For-Service (PFFS)
Are there penalties if someone does not enroll in Medicare when initially eligible? If so what is the penalty amount and how long does it last?
Yes.
The penalty for Part A is 10% of the current Part A premium, it will continue for twice the number of years the individual was elgible for Part A but did not enroll.
The penalty for Part B is an additional 10% of the Part B premium for each full 12- month period that the individual could have had Medicare Part B but did not take it. This penalty lasts as long as the individual has Part B.
What is FWA?
Fraud Waste & Abuse
When does underwriting apply to Medicare recipients?
ONLY if they are enrolling into a Medsupp OUTSIDE the Initial Enrolment period or outside of a "GI Right".
*Advantage plans have no underwriting, but could divert certain individuals into a certain plan that accommodates specific medical needs.
Is there a penalty for late enrollment? If so, what is it?
Yes. The penalty is calculated by Medicare by multiplying 1% of the "national base beneficiary premium" times the full, uncovered months the individual did not have Part D or credible coverage. The monthly premium is rounded to the nearest $.10 and added to the monthly Part D premium.
$32.74, in the year 2023.
Of those who are enrolled in Original Medicare Part A and Part B and live in the service area what group is ineligible to enroll in Medicare Advantage?
Those who have End Stage Renal Disease (ESRD).
**These people have specific plans for (ESRD)***