Medicare & Benistar
The federal government offers healthcare for post-65 retirees through the national healthcare program known as Medicare. Medicare is broken down into four distinct parts, A, B, C, D. Each of the four segments of Medicare deal with different programs designed to meet the needs of the retiree population. A summary will be given for each of them below. Benistar Administration Services specifically deals with parts A, B & D within the scope of consultation and administration of group supplemental coverages throughout the United States.
*Medicare can also cover some pre-65 disabled individuals, most commonly patients with end stage renal disease. Coverage for these patients require special permission from our vendor partners.
*All numbers shown are for 2017 Medicare standards, 2018 TBD
Medicare Part A
Medicare Part A is a basic coverage that handles the most necessary of medical expenses, specifically costs involving hospital stays, skilled nursing facilities, home health and hospice care. Part A functions as an 80% coinsurance after a $1,316 deductible each billing period. When a retiree turns 65, they are automatically enrolled in Medicare Part A. Within Medicare Part A exists a tiered system that covers all of the costs for the first 60 days of in-patient care, and then reduces benefits for the remainder of the hospital stay (refer to link for more detailed information).
If you are a U.S. citizen, or permanent resident, and have paid social security taxes for at least 10 years, the Medicare Part A benefit premium is waived. For up to date information regarding Medicare part A costs and benefits, please follow this link: https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html
Through our excellent carrier partner(s), Benistar coordinates Part A supplemental coverage benefits for retirees on a group platform. Oftentimes, our supplemental plans eliminate all of the cost of the deductible and other expenses for Part A coverage, rounding out the benefits to truly make hospital stays and in-patient care a burden-free time of healing for our clients.
Medicare Part B
Medicare Part B covers out-patient services, including, but not limited to: physician services, laboratory tests, x-rays, mental health care, preventative care, durable medical equipment, hospital outpatient services, ambulance services and blood work. Part B is an optional coverage that requires you to pay a small income-based monthly premium.
You can delay entry into Part B when you turn 65. However, to avoid financial penalty, you must have creditable coverage under an employer’s health plan. For the most updated information please follow this link: https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html
Benistar offers group supplemental coverage for Medicare Part B. Our plans are highly flexible and designed to meet the needs of both retirees and employers. We offer coverage through several of the most highly respected and operationally advanced carriers in the retiree market. Working with multiple AAA-rated partners allows us to find the most competitive quote for you every time.
Medicare Part C
Insurance policies through Medicare Part C are only available through private insurance companies. These are known as Medicare Advantage plans, and take the place of Original Medicare (Part A and Part B). Retirees are free to choose the insurance policy that will best suit their needs, generally through a health maintenance organization (HMO) or preferred provider organization (PPO) plan.
An HMO plan will cover certain doctors and hospitals as long as they are within the plan’s network of providers that agree to lower their rates for plan members while meeting quality standards. PPO plans will give the enrollee the freedom to see doctors and render services that are offered by providers outside of the standard network at a higher premium. By law, whichever plan is chosen must cover at least the same health care services as Original Medicare.
*Benistar does not yet actively participate in Medicare Part C, we want our clients to have access to care everywhere they go with no penalties for obtaining care.
Medicare Part D
Part D is the newest addition to the Medicare pantheon and focuses specifically on prescription drug coverage. Medicare Part D is administered via private insurance companies either as a bundle with Part C or as a standalone plan that coordinates with Part A & Part B to build a suite of health products suited to helping seniors. Medicare Part D plans exist in three forms and are each obtained separately. The first and largest block of Part D benefits exist on the individual market, where retirees go to find coverage for themselves once they are enrolled in Parts A and/or B.
There are two ways to obtain government subsidy for retiree drug costs: RDS (Retiree Drug Subsidy Program) and the EGWP (Employee Group Waiver Plan). RDS was the more common option when Medicare Part D rolled out in 2006 and provided employers significant cost savings, provided they had the administrative force necessary to drive the process. RDS functions by reimbursing a portion (28%) of eligible retiree costs for prescription drugs. Unfortunately RDS is not an efficient program for smaller and midsize companies who don’t have the manpower to track, file, report, and reconcile all of their prescription spending for the year.
The EGWP is quickly overtaking the RDS strategy for many businesses who are looking to continue providing prescription drug coverage for their employees after retirement. EGWPs can be either self-funded or fully-insured, both of which have government subsidy built into them, helping to reduce premiums. Therefore, private insurance companies can offer competitive rates while significantly reducing administrative burden for employers.
Benistar specializes in Part D EGWP benefits. As a leading national consultant and product developer for this product, we have helped to develop and grow this marketplace. As innovators and administrators we strive to ensure that every client receives the very best in care and service. For more information on EGWP’s or Benistar, please refer to our website, http://www.benistar.com/ or contact our sales office via email at firstname.lastname@example.org for details.