Medicare is our federal health care insurance program for the elderly and disabled. Even though Medicare has been around for fifty plus years, understanding all the nuances can be challenging. What follows is a brief overview with some links to additional resources. Please remember that Elder Law of East Tennessee is here to help you understand and maximize the benefits that are so crucial to getting appropriate, high-quality care.
Medicare benefits are divided into four types of coverage:
Part A - Covers 80% of hospital costs. Beneficiaries pay an annual deductible and a 20% copay. All Medicare beneficiaries are covered by Part A. Usually there is no premium associated with Part A. Parts B and D are optional and beneficiaries do pay premiums.
Part B - Covers 80% of the Medicare approved amount for outpatient services such as routine doctor visits, laboratory work, home health, hospice, and some durable medical equipment. The an annual premium for Part B that is typically deducted from the gross amount of the beneficiaries' monthly social security check. While enrolling in Part B is optional, failing to enroll early will result in a penalty in addition to the premium.
Part C - Rolls Parts A & Part B into managed care plans or Medicare Advantage Plans. Services covered under Part C must be the same as traditional Parts A & B, but the extent to which those services are covered is managed by the particular provider. Opting for a Part C plan rather than traditional Part A & B may be an advantage for some individuals and a disadvantage for others. The decision is unique to each individual and deserves careful consideration. Situations can change over time. Individuals who opt into a Medicare Advantage Plan and later want to revert to traditional Medicare may do so during designated open enrollment periods. Anticipated health care reform are likely to ease the restrictions on switching between different Medicare insurance options.
Part D - Covers a significant part of the cost of prescription medications. Depending upon the final form of health care reform, Medicare beneficiaries will likely see expanded medication coverage under Part D in the future. There are many Part D providers. The cost of plans and exactly which medication each provider covers can vary widely. Like Part B, failing to enroll in a Part D plan at the earliest opportunity will result in higher premiums later.
Eligibility for Medicare is usually triggered when people apply for Social Security Benefits at age 65. Younger individuals may be covered under Medicare due to long-term disability. In either case, it is important to note that Medicare does not cover 100 percent of health care expenses. Therefore it is important for Medicare beneficiaries to consider purchasing secondary or supplemental insurance coverage. There are several standard supplemental or Medigap insurance categories. Premiums, however, will be different among insurance providers. It may take some legwork and time to determine which plan offers the appropriate coverage and is the best value.
One common and dangerous misconception about Medicare is that it covers the cost of nursing home care. In fact, Medicare benefits for nursing home care are very limited. Since nursing home care can cost between $5,000 and $8,000, preplanning is very important. If an individual requires skilled care in a nursing home following a hospital admission of at least 72 hours, Medicare may cover all the cost for the first 20 days. From the 21st day to day 100, the coverage decreases significantly so that the beneficiary bears most of the cost of care. After day 100, the beneficiary pays all costs associated with nursing home care.
When it comes to managing your long-term health care needs, you can see how important it is to understand just what Medicare does and does not cover. Let Elder Law of East Tennessee help ease your mind and put a plan in place that assures you will get the best care when you need it without the worry of how it will be paid for.