You cannot be enrolled in Medicare and a subsidized Covered California health plan. If you are eligible for Part A of Original Medicare, you are ineligible for the federal and state health insurance premium subsidies. If you don’t terminate your Covered California subsidized plan when your Medicare becomes active, you may have to repay all the subsidy amount you received for those months when Medicare became effective.
Posts focusing on Medicare Parts A, B, C and D, Medicare Advantage, Supplements, changes in benefits, enrollment.
Medicare Advantage plans more closely resemble a traditional health insurance plan you may have had from your employer or individual and family plan. They have predictable copayments for many routine health care services such as office visits, labs, tests, and x-rays. Most Medicare Advantage plans include the Part D prescription drug coverage within the plan. For medical services, Medicare Advantage plans have a maximum out-of-pocket amount. Once the dollar amount is met, the Medicare Advantage plan covers all future medical services at zero cost to the plan member.
All of the out-of-pocket drug cost the consumer pays goes toward pushing them through the coverage gap and potentially into the catastrophic phase. These costs would include any deductible, copayments and coinsurance of the initial coverage phase, and the 25 percent coinsurance in the coverage gap. However, in the coverage gap, the consumer’s accumulated dollar amount is credited with the drug manufacturers 70 percent discount on brand name drugs.
The great thing about Medicare is that you can build your train the way you want. You can change the train cars every year. But the important aspect is that you own the Medicare engine. You are the engineer and you can build your train the way you want it.
Covered California is expanding its dragnet to catch people who may not be entitled to the Advance Premium Tax Credit (APTC) subsidy. If you are eligible for Medicare, or have other minimum essential coverage (MEC), you are not eligible for the monthly APTC subsidy.
The underwriting holiday only excludes the Statement of Health questionnaire, other conditions may prohibit enrollment. For example, Mary, may have cancelled her Medicare Advantage plan during the Medicare Open Enrollment. Mary suffers from rheumatoid arthritis. With the underwriting holiday, she does not have to answer the Statement of Health questions, one of which is if she has rheumatoid arthritis.
The standard monthly premium for Medicare Part B enrollees will be $144.60 for 2020, an increase of $9.10 from $135.50 in 2019. The annual deductible for all Medicare Part B beneficiaries is $198 in 2020, an increase of $13 from the annual deductible of $185 in 2019.
In California, there are thirteen counties where the Medicare Advantage capitation amount will exceed $1,000 per enrolled member. This does not include any possible bonuses based on quality scores OR for any Part D Prescription drug benefits included in the Medicare Advantage plan. The lowest capitation amount is $841.14 in Imperial County and the highest is $1,158.97 in Inyo County. These figures are from the Medicare RateBook2020 that lists the capitation amounts for all counties in the United States.
The rallying cry in the 2020 presidential primaries is Medicare For All. But Original Medicare is the sort of health insurance that the Affordable Care Act set out to ban from the market place. Original Medicare has no annual caps on the maximum out-of-pocket a consumer must pay for either hospitalization or outpatient services. People can incur multiple Part A hospitalization deductibles during the year. The 20 percent coinsurance for medical services can mean some tests, imaging, and procedures can cost the consumer hundreds of dollars. Plus, there is no prescription drug coverage.
It is not intuitive that a person who is not automatically enrolled in Medicare must contact the Social Security Administration (SSA). However, the SSA is the gatekeeper of your employment and income records and therefore can make the determination of who is eligible for Medicare based on their work history.