Many of us are insured by Medicare; in fact, almost anyone 65 years of age and older is! Medicare is a federally funded program that not only serves us, but serves those of us with certain disabilities, too. Thanks goodness for Medicare, right? Here’s some more great information on Medicare:
Who is Eligible for Medicare?
You are eligible to receive Medicare benefits beginning the first day of the month in which you turn 65. For example, if you turn 65 on Dec.15,, you can begin using your Medicare benefits on Dec.1. If you are under 65 and have certain disabilities or end-stage renal disease, you may also be eligible for Medicare.
What does Medicare cover?
- Part A: Covers inpatient hospital care, skilled nursing facilities and hospice care.
- Part B: Covers outpatient care in physician’s offices and hospitals, home health care, durable medical equipment and some preventive services.
- Part C: This is a Medicare Advantage Plan. These plans are in replacement of original Medicare, are typically HMOs and cover the same services as Part A and Part B. Most also include prescription drug coverage. Medicare Advantage Plans are run by private insurance companies that have been approved by Medicare.
- Part D: Prescription drug coverage. Private insurance companies also offer these plans.
What are the Costs?
As a Medicare beneficiary, you will have out-of-pocket costs such as premiums, deductibles, co-insurance and co-payments. Premiums are the monthly payments made to an insurance company to keep coverage active. Most people will not have to pay premiums for Part A because they or their spouses have paid Medicare taxes for at least 10 years while working. Parts B, C and D do come with a monthly premium you must pay.
In addition to the monthly premiums, each Medicare component comes with its own deductible, co-insurance and co-payments. Part A deductibles work a little differently compared to other health insurance plans. The Part A deductible is charged to the patient for each benefit period, not year. A benefit period begins the day you are admitted in a hospital or skilled nursing facility and ends when you have been out for 60 consecutive days. While most health plans have one deductible to be met each year, with Part A, you could pay the deductible more than once in a year.
Typically, Part B will pay 80 percent of the allowed amount of the treatment and you will be responsible for the other 20 percent along with a yearly deductible.
Medicare Advantage plans set their own cost-sharing terms and vary widely depending on the plan. Some may charge a flat rate per hospitalization up to a set number of days. Other plans may charge a co-payment or co-insurance amount for each day in the hospital.
What if I Have Other Insurance?
While enrolled with Medicare, you can be enrolled in other insurance. If you or your spouse are still working and receiving insurance through an employer, Medicare will be secondary to that policy. Under certain circumstances, low-income individuals may be eligible for Medicaid.
If you are a military veteran, you can have Medicare along with Veteran’s Administration, or V.A., coverage but both policies cannot be billed concurrently for the same service. Unless the V.A. authorizes a particular treatment, Medicare will be billed.
To help cover some of the costs after Medicare, you can also purchase a Medicare Supplement Plan, also called a Medigap policy. These policies are run by private insurance companies and will be billed secondary to your Medicare plan to help cover your deductible and co-insurance. You cannot have a Medicare Supplement Plan if you join a Medicare Advantage Plan.
What if I Choose to Not Sign up for Medicare?
If you choose not to sign up for Medicare when you first become eligible, you could end up paying a late enrollment penalty. These penalties are added to your monthly premium for as long as you have Medicare. You may be able to avoid paying a penalty if you delayed Medicare coverage because you had other health coverage, for example, through your or your spouse’s employer. In this instance, you can enroll through a special enrollment period when you or your spouse retire and that other coverage is no longer available. FBN
By Stephanie Timonen
To learn more about Medicare, please join Northern Arizona Healthcare for a free forum. We will discuss Medicare billing practices, observation versus inpatient status, and what this all means to you. There will be plenty of Q&A time, so bring your questions!
Next forum dates:
Tuesday Sept. 19, Flagstaff Medical Center’s McGee Auditorium
- Session 1: 10-11 a.m.
- Session 2: 6-7 p.m.
Wednesday September 20, Verde Valley Medical Center’s Conference Room B
- Session 1: 10-11 a.m.
Reservations are encouraged, but not required. To RSVP, please contact Julie Kuhns at 928-213-6674 or Julie.Kuhns@NAHealth.com.
Stephanie Timonen is a patient advocate with Northern Arizona Healthcare.