|
Autumn 2012 Newsletter
Over
the summer, we presented a basic primer
on Medicare; we now pick up the
discussion with a look at Medicare Part
B.
Medicare Part B
Part B covers physician services,
laboratory fees, medical equipment costs
and rehabilitative care. Ordinarily, the
insured pays a monthly premium, which is
deducted directly from her Social
Security income. If the insured’s
adjusted gross income exceeds the
maximum amounts indicated below, then
the premiums will be higher. Below is a
chart which shows the relative premium
costs:
|
If Your Yearly Income
in 2010 was:
|
You pay
|
|
File Individual Tax
Return |
File Joint Tax Return |
|
$85,000 or less |
$170,000 or less |
$99.90 |
|
above $85,001 up to $107,000 |
above $170,001 up to $214,000 |
$139.90 |
|
above $107,001 up to $160,000 |
above $214,001 up to $320,000 |
$199.80 |
|
above $160,001 up to $214,000 |
above $320,001 up to $428,000 |
$259.70 |
|
above $214,000 |
above $428,000 |
$319.70 |
Below is a chart which shows the Medicare
deductibles:
Part B Services
|
Services
|
You Pay
|
|
Part B Deductible |
You pay $140 per year. |
|
Blood |
In most cases, the provider gets blood from a blood bank at no charge, and you won't have to pay for it or replace it.
However, you will pay a copayment for the blood processing and handling services for every unit of blood you get, and the Part B deductible applies.
If the provider has to buy blood for you, you must either pay the provider costs for the first 3 units of blood you get in a calendar year or have the blood donated by you or someone else.
You pay a copayment for additional units of blood you get as an outpatient (after the first 3), and the Part B deductible applies. |
|
Clinical Laboratory Services |
You pay: $0 for Medicare-approved services.
|
|
Home Health Services |
You pay: $0 for Medicare-approved services. You pay 20% of the Medicare-approved amount for durable medical equipment.
|
|
Medical and Other Services |
You pay: 20% of the Medicare-approved amount for most doctor services (including most doctor services while you're a hospital inpatient), outpatient therapy*, and durable medical equipment.
|
|
Mental Health Services |
You pay: 40% of the Medicare-approved amount for most outpatient mental health care.
|
|
Other Covered Services |
You pay: copayment or coinsurance amounts.
|
Outpatient Hospital Services |
You pay: a coinsurance (for doctor services) or a copayment amount for most outpatient hospital services.
The copayment for a single service can't be more than the amount of the inpatient hospital deductible. |
Physicians who accept
Medicare payments for medical services provided are said to “accept assignment.”
The insured still would be responsible to pay any deductibles and copayments,
but Medicare would pay the rest. A physician is not required to accept
assignment, and if she does not, then the insured would be responsible for any
deductibles, copayment and the difference between Medicare’s approved fee and
the physician’s fee.
Medicare Part C
Part C, or Medicare
Advantage, is managed care, like health maintenance organization plans (HMO) or
preferred provider organization plans (PPO,) which is offered by private health
insurance companies that are approved by Medicare. The plan includes coverage of
Medicare Parts A and B, plus additional coverage for prescription drugs, dental
services, vision and hearing care.
In fact, your
insurance company is a private one, but Medicare pays your premium to the plan,
monthly. Ordinarily, one must obtain medical services within the network, so if
you have a favorite doctor, you may not be able to obtain coverage when you see
him. In addition, a referral is ordinarily required in order to see a
specialist.
Medigap
Basically, Medigap
plans supplement basic insurance coverage that would not be covered (hence the
term, “gap”) by Parts A and B, except for long term care. There are fourteen
different types of policies, at present, and each is designed to supplement
different gaps in Medicare coverage. Some offer additional coverage for
copayments or deductibles, foreign health care and home care. Each is designated
alphabetically, specifically, A through N. One must be a careful and savvy
consumer in order to obtain-and when to obtain is very important-the best value
for one’s needs.
Part D
Part D is prescription
drug coverage which has premiums, deductibles, copayments and gaps in coverage.
Anyone interested should research to make a determination that Part D is cost
effective for his needs. Since it is expensive, and on 60 days notice, one can
be notified that his drug is no longer covered, we are reticent to recommend
participation, except in very limited cases. Here’s a case where one must do his
homework.
The
above charts were provided through the
courtesy of
www.medicare.gov.
###
END OF NEWSLETTER ###
|
