Tag Archives: Social Security

Ca Medicare Vital Info And Facts

Lots of individuals become confused when studying Medicare. There are scores of distinct companies and schemes so the entire area can be complicated when attempting to see the point of what is in effect being offered. There can even be deviations between counties. So that you can make it to an informed evaluation on what type of Ca Medicare is largely fitting to your state of affairs and future, you want to have some basic information on the assorted aspects. To begin with you must be educated that largely Medicare beneficiaries are above age of 6 , but if you are younger than this and acutely disabled then you can additionally sign up.

There are lots of plans all of which present a different variety of insurance, these will come with different prices and premiums. Any cost of a Medicare plan is apt to rise on a yearly basis to fit inflation and the existing expenses of health care. Also you ought to take in that precise benefits can alter each year so you have to keep yourself updated with the current news broadcasts.

Medicare is made-up of 4 distinct sections. Part A is what is also known as hospital insurance. This will cover the cost of most kinds of in-patient care such as hospital or hospice. To be considered for this portion without having to pay a premium each month, you would have to be holding at least 40 quarters of Social security credits. If you only have 30 to 40 credits then you must pay a monthly premium of $254 . If you have less than 30 credits then the monthly charge is increased to $461.00 throughout 2010.

Part B of Medicare handles outlay from outpatient treatment. This will insure the person for any outpatient treatment, laboratory tests, physical therapy, speech therapy, and also doctor’s fees. It may too insure some costs of medical materials, and ambulance transfer. Part B is voluntary; you are not forced to enlist. Lots of citizens who are still in work may have a similar plan from their workplace health insurance scheme so it is normal to wait pending retirement before choosing this preference.

During 2010, the rate of the Part B monthly premium is set at $110 , but if you already joined the system in 2009 you will just have to pay the last premium of ninetysix dollars . The logic for this is that these persons will not be given a cost of living correction in their Social Security benefit unless Government changes the policy. But if your year-end pay packet has increased then you will have to pay the newer prices.

It is vital to understand that Medicare does not bestow a full comprehensive scheme for all your medical linked requirements. A few parts such as hearing aids, dental treatment, eyewear, and long term private or nursing home care will have to be met out of your own pocket.

Medicare Advantage is a different name for Medicare Part C. This is an option which replaces the fee for service portion of Medicare. The government sponsored program will pay private insurance businesses to insure the health costs of beneficiaries’ schemes. To be eligible for this type of cover you must have formerly selected to enlist for Parts A and B of a Medicare program. If you want to join Part C you will remain qualified for all the advantages that are offered with the Medicare policies.

The discrepancy is that you will accept the reimbursement from a private plan. Many of these may also include the costs of prescribed medicines, if so the program is referred to as an MA-PD. Without the prescriptions cover it is called an MA-only program. It is repeatedly the case that a Medical Advantage scheme has true advantages over the initial variety of Medicare.

You must be aware that a Medical Advantage plan may be more pricey than the typical format, nonetheless in some circumstances it may be cheaper. An added consideration is that it may demand that you can only use physicians and medical services that are part of the Advantage network. There are 5 special programs that fall under the Medical Advantage class. These are: PPOs (Preferred Provider Organizations), HMOs (Health Maintenance Organizations), PFFS (Private Fee-for-Service policies), MSAs (Medical Savings Accounts), and SNPs (Special Needs plans).

The concluding division of Medicare, Part D, is related to medications. It will provide cover no matter what the salary or physical status of the exact individual. To be entitled you would have to join and pay premiums towards a prescription scheme.

Medicare Part A And Part B Enrollment

Sooner or later, it is time to enroll into Medicare. Knowing when to get it can be confusing. This article covers how to get Medicare Part A and B, and when to sign up for them. Part C and D sign ups are also covered. All parts of Medicare have and initial and annual enrollment periods.

You can receive Medicare when you reach 65. You automatically receive Medicare Part A and Part B when you start receiving benefits from either Social Security or the Railroad Retirement Board. Your hospital insurance is covered under Medicare Part A. Your medical insurance is covered under Medicare Part B.

You do not need to keep Part B. You need to let Medicare know that you do not want Part B. Your Medicare card has directions.

If you are still working and do not yet get Social Security or RRB benefits, you will not get Part A and Part B automatically. If you don not get Medicare automatically, you will need to sign up. You will need to contact either the Social Security office or RRB to sign up for Medicare.

The initial enrollment period for Part A and Part B begins three months before the month of your 65th birthday. The period extends for another 3 months after your birthday month. The sign up period is for seven months. For your coverage to begin the month of your birthday, you must sign up in the three months prior to your birthdy month. If you enroll after that, your coverage will be delayed.

You do not need to enroll during the initial period. You can sign up later. You can sign up between January 1 and March 31 of each year. Your coverage then begins on July 1st. If you do not sign up during the initial enrollment, you will pay a higher premium.

You can get Medicare Part C instead of Medicare Part A and Part B. The initial enrollment period is the same as Part A and Part B. But you do not have to choose between Part C and Part A and B at that time. You can switch at a later date.

There is an annual open enrollment for Part C. Open enrollmenti s between October 15 to December 7. You can switch from Medicare Part A to Part C during the enrollment period.

You can change from Part C to Part A and B once a year. This time period occurs between January 1 and February 14.

The Medicare Drug plan is part D. You can enroll at the same time you are allowed to enroll for Part A. If you do not enroll in Part D at that time, you have opportunity to enroll during the same time frame as the Medicare Part C open enrollment. Not enrolling in Part D during the initial enrollment period will result in higher premiums.

In summary, you should try to sign up for Medicare Part A and B or Part C,and part D when you are first eligible. Your premiums will be lower. If you miss the initial enrollment, you have opportunity to enroll annually.

Medicare Increase Deductibles And Copays For 2011

The 2011 Medicare copay and deductible information is available. In being true to our promise to provide you with the best products, services and marketing support to grow your business, we have begun the process of updating our marketing materials (brochures and outlines) and making them available early December. A reminder communication with the 2011 form numbers will be sent at that time.

2011 Medicare Deductible and Coinsurance Increases

As always, our 2011 Medicare supplement benefits match the federal programs deductible and coinsurance increases, a distinct advantage in todays ever-changing environment.

2011 Medicare Supplement Feature:

1. Part A Inpatient Hospital Deductible – $1,100 (in 2010)- $1,132(in 2011)

2. Hospital Coinsurance
61-90 days – $275 (in 2010) – $283(in 2011)
91-150 days (lifetime reserve) -$500 (in 2010) – $566(in 2011)

3. Skilled Nursing Facility Care Coinsurance –
21-100 days – $137.50 (in 2010) – $141.50(in 2011)

4. Part B Physicians Services and Supplies Deductible -$155 (in 2010)- $162(in 2011)

Most Medicare beneficiaries will continue to pay the same $96.40 Part B premium amount in 2011. Beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium will not have an increase in their Part B premium for 2011. For all others, the standard Medicare Part B monthly premium will be $115.40 in 2011, which is a 4.4% increase over the 2010 premium. The Medicare Part B premium is increasing in 2011 due to possible increases in Part B costs. In 2011:

A) New Part B beneficiaries will pay $115.40 (because they did not have the premium withheld from their Social Security benefit in the previous year).

.
B) Beneficiaries who do not currently have the Part B premium withheld from their Social Security benefit will pay $115.40.

Higher-income beneficiaries pay $115.40 plus an additional amount, based on the income-related monthly adjustment amount (IRMAA).
If you have questions, please call Sales Support at (800) 693-6083

New to Medicare A Guide to Your Initial Enrollment Period

Are you new to Medicare? If you or a loved one are nearing the age of 65 or are otherwise eligible for Medicare coverage, you probably have questions surrounding Medicare enrollment, out-of-pocket costs, coverage and more.

Medicare Initial Enrollment Period Guide

Eligibility

If you’re aging into Medicare (rather than qualifying for another reason, like certain health conditions), you’re eligible to receive Medicare benefits on the first day of the month in which you turn 65. (If you are born on the first of the month, your benefits start the first of the prior month.) If, for example, your birthday is May 27, 1946, your coverage will begin May 1, 2011. You have a period of seven months during which you may enroll. Your Initial Enrollment Period (IEP) begins three months before your 65th birthday, runs through your birthday month, and ends three months after your birth month.

If you’re nearing your IEP, it’s a good idea to start doing your research before it begins. Allow yourself plenty of time to select the Medicare plan(s) that meet your needs and your budget. If you don’t enroll during your IEP, you may pay penalty fees or have to wait until the Annual Enrollment Period (AEP) to make your selection.

Research

There are several Medicare coverage choices available through both government run and privately insured programs, and plan availability varies depending on where you live. It is important to shop around before enrolling in Medicare.

Original Medicare is administered by the federal government and consists of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Medicare Part A is of no cost to you if you or your spouse made payroll contributions to Social Security for a minimum of 10 years. You will, however, pay a premium for Medicare Part B, and the amount will depend on your annual income. In 2011, Part B premiums range from $115.40 to $369.10 per month.

Medicare Part D helps pay the cost of prescription drugs. If you’re interested in Medicare Part D you must enroll through a private insurer. If you delay enrolling when you first become eligible, you may pay a penalty on your premium in the future unless you qualify for an exception.

Medicare Advantage (Part C) plans are offered by private insurance companies approved by Medicare. Part C plans combine coverage for hospital stays and doctor visits in a single plan. You may choose a Medicare Advantage plan that includes prescription drug coverage, or select one without.

Medigap, also known as Medicare Supplement Insurance, are also provided by private insurance companies. Designed to help with costs not covered by Original Medicare, there are 10 standardized Medigap plans labeled -A- through -N-. These plans typically cover some coinsurance, deductibles and excess charges that Medicare does not cover. The application process and terms are different for Medigap plans than the other plans discussed here; enrollment isn’t limited to a certain time of year. Read -Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare- for more information.

Enrollment

Once you are eligible and have selected the Medicare plan(s) that you feel best meet your needs, it’s time to enroll. If you’re already receiving Social Security you will automatically be enrolled in Medicare Parts A and B. If you’re not yet receiving Social Security you will need to enroll with your local Social Security office. In order to enroll in a Medicare Advantage or Medigap Plan, contact the insurance company who provides the coverage you’ve selected. If you miss the Initial Enrollment Period you will need to wait until the Annual Election Period (AEP) to enroll. Again, Medigap plans work a little differently, so read more about Medigap coverage in your state.

Review or Change your Selection Annually

You have an opportunity once a year to change your Medicare Coverage. In 2011, this Annual Election Period runs from October 15 to December 7.

Before AEP begins, it’s a good idea to evaluate your medical costs, your healthcare needs, and any changes that may have been made for the coming year’s plans. This will prepare you to make changes to your coverage selection if you choose to. (Changes in the coming year’s plans are announced by the Center for Medicare Services annually; see www.cms.gov for details.) Unless you qualify for an exception, this is your one annual opportunity to change your Medicare selection.

For more information contact the Medicare helpline 24 hours a day, 7 days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. You can also contact the UnitedHealthcare Medicare Made Clear hotline to learn more 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, 7 days a week.

The family of UnitedHealthcare Medicare Solutions plans are insured or covered by an affiliate of UnitedHealthcare, a Medicare Advantage organization with a Medicare contract and Medicare-approved Part D Sponsor.

Y0066_110427_115625 File & Use 05072011

Medicare Part B And Its Eligibility

Medicare Part B eligibility is not difficult to figure out – all those who have eligibility for Part A are also entitled to Part B; all you have to do is bear the excess expense by paying a monthly insurance premium. This particular amount could be drawn from your retirement benefits or the Social Security amount you will get.

If you have Part A: All people residing in the USA who’re eligible for Medicare Part A without any premium are also entitled to Part B as well. Then again, Medicare Part B eligibility doesn’t really extend to the people residing in Puerto Rico. You need to understand an essential point here, Medicare coverage under Part B isn’t compulsory. This is usually a voluntary plan, and to receive coverage within this, you have to pay a monthly premium contrary to the Part A coverage that comes free of cost.

For those who do not have Part A: Even persons who don’t have Part A coverage can certainly decide on Medicare Part B as long as they satisfy a few Medicare eligibility requirements. For one, they should be citizens of the United States. Even non-citizens are eligible, provided they have been admitted following all the specified legal requirements and have resided in the US for five years or more. Secondly, people who are aged 65 years and above are eligible for Medicare Part B. Even if you do not have Part A, you can qualify for the Part B by filling out the necessary paperwork and remitting the monthly premium specified by the insurance provider.

Why Choose Part B?

Medicare Part A provides medicare coverage for hospitalization expenses. However, there can be many circumstances when you may require additional care at home or at a health care facility or a hospital on an outpatient basis. Say you have a minor accident that causes you a sprain – you may not need to be hospitalized, but you may require an X-ray to rule out a fracture, a visit to the physician to obtain a prescription for painkiller medication, or physical therapy for a few days to deal with the pain and inflammation. In such cases, having Medicare Part B is crucial if you wish to keep your health care expenses low.

If you have overlooked the fact that you have Medicare Part B eligibility and not chosen this plan in the beginning, you can still enroll for it. All you need is to fill out the prescribed Medicare application and provide the necessary documentation along with the monthly premium amount. Of course, you need to pay a slightly higher amount as this premium when you enroll late and not in the initial stage.

Medicare And California Sales Tax An Analysis

Theres a rumor going around that a 3.8 percent sales tax will be applied to home sales in order to fund Medicare under the Affordable Care Act. Although that rumor is patently false, there has always been sales tax associated with certain Medicare-covered transactions.

Specifically, if your firm sells medical supplies and has been treating sales under Medicare Part B (Medicare B) as exempt from California sales tax, it is sitting on a fiscal time bomb. Since the program began, the California State Board of Equalization (Board) has been regularly assessing sales tax on Medicare B transactions in its audits.

Even businesses reporting correctly are generally confused about why sales under Medicare B are treated differently from sales under Part A. This article will discuss the different treatments and explain how sales tax applies to Medicare receipts in general.

Some sales under Medicare are always exempt, simply because the products involved fall under the general California exemption for prescription medicines. However, such transactions are outside the scope of this article, which solely addresses products ordinarily considered taxable when sold to patients. (Medical services are exempt from sales taxes in general, in California and nearly everywhere else.)

In order for an otherwise taxable product to be exempted from sales tax under Medicare, the product must be considered sold to the United States government rather than to the patient. Sales to the U.S. government are exempt from sales tax for Constitutional reasons. This exemption has been codified in California Revenue and Taxation Code Section 6381 and is further delineated by Sales and Use Tax Regulation 1614.

Whether a Medicare transaction is considered an exempt sale to the U.S. government or a taxable sale to an individual patient depends on whether the sale falls under Medicare Part A or Part B. All sales under Part A are regarded as exempt sales to the U.S. government. Sales under Part B are considered made directly to the patient, and they are taxable unless some other exemption applies (such as the exemption for sales for resale or sales in interstate commerce). Differences between Parts A and B that give rise to this distinction are discussed below.

Financing and Participation:

Medicare A is financed through payroll withholding and self-employment taxes. Participation is mandatory for anyone within the Social Security system. Most people who pay the taxes that fund Medicare A are under retirement age and not yet eligible for Medicare coverage.

Medicare B is financed partly through monthly premiums paid by those covered under the program. The rest of the financing comes from general funds of the federal government. Anyone covered by Part A is eligible for Part B, but participation in Part B is optional. Once participants enroll in the Medicare B program, they are required to pay the monthly premiums, generally through withholding from their Social Security checks.
Cost to Participants:

Medicare A is funded entirely through self-employment taxes and the Medicare percentage withheld from employee paychecks and matched by employers. There are no costs specific to participants.

Medicare B is charged directly to each participant, generally by a monthly deduction from the participants Social Security check. The monthly costs are considered medical insurance premiums and may be claimed as an itemized deduction on the participants income tax return.
Payment of Claims:

Medicare A payments are made directly to providers of medical products or services under a procedure mandated by federal law. Since the law requires direct payment by the U.S. government to providers, medical supplies sold by providers under Medicare A are considered sold to the U.S. Government.

Medicare B payments may be made either to providers or patients. If a provider has agreed to accept assignment of Medicare benefits (which essentially constitutes agreement to accept Medicares version of reasonable charges), the provider prepares and submits a claim form and is reimbursed directly by the insurer acting on behalf of the U.S. government. The patient pays only the deductible, co-insurance or non-allowable costs.

If the patient uses a provider who has not agreed to accept assignment of benefits, the patient pays the entire charge and then files a claim for reimbursement. Any such reimbursement goes directly to the patient. Under Medicare B, payments are considered reimbursements of charges to the patient, whether the payments go directly to the patient or to the provider on the patients behalf.

The U.S. Governments Position:

Medicare A does not allow reimbursement for sales taxes charged on medical supplies, based on the theory that providers are selling to the U.S. government and the sales are therefore exempt.

Medicare B has built sales taxes into its calculations of reasonable charges, as stated in Medicare Carriers Manual section 5213. In accepting sales taxes as allowable charges under Medicare B, the U.S. Department of Health and Human Services has taken the position that sales under the program are not sales to the U.S. government.
Sales Tax Effect:

Medicare A payments are made directly by the U.S. government to providers under federal law, which theoretically results in sales to the United States as discussed above.

Medicare B payments may be made either directly to patients or to providers for the benefit of patients, depending on each patients choice of provider. The patients ability to make this choice has been interpreted to mean that payments under Medicare B are simply reimbursements to patients. Under this patient reimbursement theory, any sale by the provider under Medicare B is made to the patient rather than the United States, regardless of which party prepares the claim form or receives the reimbursement check.

Both the U.S. Department of Health and Human Services and the State Board of Equalization have accepted these legal interpretations, and it appears unlikely that an effort to re-characterize sales under Medicare B as sales to the U.S. government would prevail. If the law is ever changed to make direct payments to providers mandatory under Part B, the application of sales tax could well change with it.

Although subject to tax, amounts claimed for 80 percent reimbursement under Medicare B are considered to include applicable sales taxes, because the Medicare Carriers Manual defines reasonable charges as including such taxes. Accordingly, when providers report their taxable sales to the Board, they are entitled to claim a deduction for sales taxes included in Medicare B reimbursements.

Conclusion:

The theoretical justification for distinguishing sales under Medicare A from sales under Medicare B may not be entirely logical, but compliance with the Board of Equalizations interpretation is the only prudent approach. If you have been treating all sales under Medicare B as exempt, you should now begin reporting those sales as you would report sales to any private party.

But what about earlier periods? If your firm is selected for a Board audit, you undoubtedly will be billed for additional taxes for those periods. However, the amount of additional taxes may be subject to adjustment. This is true not only for Medicare sales but for any area where tax changes are recommended by Board auditors. Audits incorporate assumptions and tests that often can be modified and occasionally can be overcome.

Always remember that you have the right to review any tax auditors working papers or have a sales tax expert review the audit on your behalf. Exercising that right will at least bring you peace of mind. It might also result in significant tax savings.