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Coverage Options

Medicare was created in 1965 to give people age 65 and older health insurance coverage once they retired. Today some under age 65 can also receive Medicare due to disability or disease. Most people are automatically enrolled on Medicare Part A when they turn 65. For those receiving their Social Security check at age 65 they will also be automatically enrolled in Part B, unless they choose to defer enrolling in Part B having credible coverage through an employer.

Medicare has four Parts: A, B, C and D.

Medicare Part A- Inpatient Coverage

Part A covers your hospital stays, skilled nursing facility stays and hospice. Part A has reoccurring deductibles along with copayments.

Medicare Part B- Outpatient Coverage

Part B covers your doctor’s appointments, outpatient lab and diagnostic testing, physical therapy and durable medical equipment along with many other benefits. Part B has a monthly premium of $99.90 for most people unless you as a single earn more than $85,000 or $170,000 as a couple. Part B has an annual deductible to satisfy first than covers Part B expenses at 80%.

Medicare Part C - Medicare Advantage

Medicare Advantage plans are offered by private insurance companies and cover Part A, B and usually Part D. With Part C the insurance companies are receiving a monthly payment from the government to administer people’s Medicare. The monthly payment from the government varies by county and state and is reset every August for the following year. Most Medicare Advantage plans have a network of providers and to use a provider out of the network is either a higher cost or may not be covered. Medicare Advantage plans also have copayments and coinsurance but often come with a lower monthly premium than supplement plans.

Medicare Part D - Prescription drug coverage

Part D is prescription drug coverage offered by private insurance companies. Part D is a “voluntary” program with a penalty if you choose not to select a plan when eligible, unless you have “credible coverage”. All Part D plans have possible copays and are subject to coverage gap or donut hole. Many states have programs to help those that qualify with their prescription drug costs.

For more information, visit www.medicare.gov

Medicare’s Costs

Part A has a deductible of $1,156 for hospitalization that resets once someone is home for more than 60 days. For hospital stays last more than 60 days there are copayments of $289 per day for days 61-90 and $578 per day for days 91-150 (using lifetime days). The first 20 days of a Medicare covered stay in a Skilled Nursing Facility is fully covered but there is a $144.50 per day copayment for days 21-100.

Part B has an annual deductible of $140 and all of the Part B expenses above the deductible are covered at 80% by Medicare and 20% by the Medicare beneficiary.

Go to www.medicare.gov for more information.