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Summer 2012 Newsletter
In
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
or www.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:
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$0 for home health care services
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20% of the Medicare-approved
amount for durable medical equipment
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Hospice Care
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You pay:
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$0 for hospice care
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A copayment of up to $5 per
prescription for outpatient
prescription drugs for pain
and symptom management
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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:
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$1,156 deductible per benefit
period
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$0 for the first 60 days of
each benefit period
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$289 per day for days 61-90
of each benefit period
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$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:
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$0 for the first 20 days each
benefit period
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$144.50 per day for days 21-100
each benefit period
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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
of www.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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