| Summer 2012 NewsletterIn our Spring Newsletter we examined some Medicare issues as they related to certain Social Security programs. In this Newsletter, we are going to present a more in-depth analysis of the Medicare program, what it does and how it works. Medicare is federal health insurance which covers senior citizens and certain disabled individuals. Anyone who attains the age of 65 can apply for Medicare, regardless of whether he is receiving Social Security benefits, although one must be Social Security eligible. Unlike Medicaid, there are no income or resource eligibility requirements. One can apply on-line at www.ssa.gov orwww.medicare.gov; the websites are fairly easy to navigate.
Types of Plans
Medicare has several distinct plans: Part A which is hospitalization or hospital insurance; Part B which is coverage for physicians, laboratory tests, medical equipment and rehabilitation; Part C which is their managed care plan; Part D, the prescription drug program; and Medigap which is supplemental coverage to Parts A and B.
What Services are Covered?
Firstly, medical services must be provided by a hospital, laboratory or physician that is Medicare approved. Secondly, the medical services must be medically necessary, that is, those services are required in order to diagnose or treat an acute or chronic illness or injury. Thirdly, the medical services must be provided to the insured in the United States. Below is a chart which shows the general premium costs:
Medicare Monthly Premiums
Medicare Part A
Part A is hospital insurance which covers inpatient services for hospital stays, hospice care, and, in a very limited way, institutional and community long term care. While there is no premium for this coverage, the insured is responsible for deductibles and copayments. Ordinarily, the copayments are as follows: the insured pays 20%, and Medicare pays the other 80%. The deductibles are shown in the chart below:
Medicare Part A (Hospital Insurance) Costs
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Services
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You Pay
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Blood
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In most cases, the hospital gets blood from a blood bank at no charge, and you won’t have to pay for it or replace it. If the hospital has to buy blood for you, you must either pay the hospital costs for the first 3 units of blood you get in a calendar year or have the blood donated.
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Home Health Care
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You pay:
- $0 for home health care services
- 20% of the Medicare-approved amount for durable medical equipment
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Hospice Care
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You pay:
- $0 for hospice care
- A copayment of up to $5 per prescription for outpatient prescription drugs for pain and symptom management
- 5% of the Medicare-approved amount for inpatient respite care (short-term care given by another caregiver, so the usual caregiver can rest)
Medicare doesn’t cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).
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Hospital Inpatient Stay
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You pay:
- $1,156 deductible per benefit period
- $0 for the first 60 days of each benefit period
- $289 per day for days 61-90 of each benefit period
- $578 per “lifetime reserve day” after day 90 of each benefit period (up to a maximum of 60 days over your lifetime)
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Skilled Nursing Facility Stay
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You pay:
- $0 for the first 20 days each benefit period
- $144.50 per day for days 21-100 each benefit period
- All costs for each day after day 100 in a benefit period
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We will continue our discussion of Medicare, starting with Medicare Part B, in the autumn. Have a wonderful rest of the summer……….
The above charts were provided through the courtesy ofwww.medicare.gov.
The above list is for general information purposes only. It is not intended to constitute individual legal advice or a specific recommendation to any particular client.
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