MEDICARE is a benefit available to most people over 65 OR people who have been determined to be disabled by the Social Security Administration.
PART A MEDICARE is for Hospital Coverage, rehabilitation, hospice and short term home care. Typically there is no premium for this coverage. However there is an inpatient hospital deducible. In 2015 it is $1260 per hospital stay, per 60 day period.
PART B MEDICARE is for medical doctors, outpatient care and durable medical equipment. There is a monthly premium taken directly from your Social Security benefit. For most people the premium is $104.90 (in 2015). For incomes over 85k (single) or 170k (married), the part B premiums will be higher. In 2015, the annual deductible is $147/year. Medicare Part B covers only 80% of services received. You are responsible to pay the other 20%.
PART C is for Supplemental or Medicare Advantage Plans (also known as HMO or PPOs). These plans are used to offset what Medicare does not cover. The cost for these plans range from -0- to several hundred dollars per month depending on the level of coverage your opt for.
Most Medicare Advantage plans are low cost, include medications but have co-pays for MD visits and hospital stays. They also have a network of doctors you must use.
Medicare Supplemental plans are more costly (premiums ranging from $200 – $500/month) but often provide 100% coverage for hospital and medical services. Also you have more flexibility with choosing doctors.
PART D is for Prescription coverage. Fees are based on plan chosen and range from -0- (for low income) to $75+ per month. Most medication have co-pays even with the plans. There is also a “donut hole” after you and/or your plan spend $2960 on medications. Then you pay about 45% for brand name (and 65% for generic) of the plans cost for the drugs. Once total out of-pocket spending reaches $4,750, beneficiaries pay either five percent of total drug costs or $2.65/$6.60 for each drug.
Both Supplemental and Medicare Advantage plans cover the following:
*Short term home care after an acute illness (ie; visiting nurse services) – This may last up to 9 weeks but services are often limited. Home health aides usually come for 1-2 hours only 2-3/week. They will only assign a home health aide if you need assist with bathing. An aide will not be assigned if this type of assistance is not needed.
Regardless, Medicare will not pay for long term custodial care.
*Short term rehabilitation after a qualifying 3 day hospital admission. With traditional Medicare, the first 20 days are covered 100%. Day 21-100 there is a daily co-pay of 157.50/day (in 2015). Some Supplemental policies cover this cost (plans C, D, G, M and N) and some do not! Most Medicare advantage Plans have a daily co-pay and this could start on day 1.
