By Beth Sullivan, CIC, CAC, SHIP Counselor
Does Medicare have you confused? Do you want an explanation that you can understand? Let’s start at the very beginning. I hear it’s a fine place to start.
Medicare A is Hospital Insurance. It is usually free if you or your spouse has worked enough quarters to earn 40 work credits. About 99% of Medicare beneficiaries do not pay a premium for part A.
Medicare A hospital coverage is measured by benefit periods, not the calendar year. The benefit period starts the first day you receive Medicare covered inpatient services and lasts until you are out of the hospital or a skilled nursing facility for 60 consecutive days. Then, the benefit period starts over again. The deductible in 2016 is $1,288 per benefit period.
Medicare B is Medical Insurance. Medicare B covers 80% of your medical care. Medicare B has a monthly premium that is usually deducted from your Social Security check. In 2016, several changes were made to Part B. The deductible is now $167 per year for all participants. The premium varies, depending on your income. If your Medicare premium is being deducted from your social security check, it will stay the same at $104.90. If you are enrolling in Medicare for the first time and your income is less than $85,000 per year, your premium will be $121.80, plus a $3.00 service fee for a total monthly premium of $124.80.
Medicare B covers most doctor visits, lab tests, x-rays, outpatient procedures and emergency room visits. Part B covered services are generally covered at 80%, with the patient being responsible for the rest. Be sure and check to see if your doctor provides services to Medicare patients, so you are aware of your costs before being seen. However, unlike private insurance companies, there is no out of pocket maximum for Medicare.
Medicare C is also known as Advantage Plan. These plans include Part A and Part B and, usually, Part D. To find an Advantage plan, it is good to get your information from an unbiased source like the State Health Insurance Assistance Plan, also called SHIP. In Indiana the number is 1-(800) 452-4800.
Medicare D is Prescription Drug Plans. These plans are required by law and if you do not enroll when first eligible, you will be assessed a penalty for every month you do not have it. A SHIP Counselor will be able to help you find coverage, or you can visit Medicare.gov.
The Medicare that does not have a letter
Medigap is also called Medicare Supplemental Insurance. These policies help defray the cost of the patients 20% that Medicare B does not cover and can also help with deductibles. There are many plans to choose from and a SHIP counselor is a good resource to help with this also.
Note: If you would like more information, please visit www.windrosehealth.net for our locations. You can schedule an appointment with one of our Eligibility Navigators and/or a SHIP Counselor.