Paying for Medicare care costs can be expensive in light of the multiple government loopholes. For some seniors even making basic premium and copayments is impossible or at least very difficult. Luckily, states provide assistance to seniors in such a predicament. Assistance comes from three systems: Medicaid, qualified Medicare beneficiaries, or specified low income Medicare beneficiary.
What are your Long-Term Care Options?
Medicare pays healthcare for seniors through the various Medicare Parts. But one area where Medicare is lacking is long-term care. This is becoming a bigger issue as more and more people live longer lives. Long-term care refers to places like nursing homes or assisted living centers. Unlike skilled nursing facilities or home health care agencies, there is potentially no end to how long a person could possibly stay in a nursing home. We will be discussing the options available to you as you plan out your or your loved ones' retirement healthcare needs.
Medicare Part B - Medical Insurance
Medicare Part B is the medical insurance component of Original Medicare, it pays for outpatient care such as trips to the doctors office and tests, like x-rays or MRIs. Unlike Medicare Part A, you are not automatically enrolled. Like any other insurance you will have to pay a premium, deductible, and copayment. Your Medicare care must also be necessary and provided at a Medicare-approved doctor’s office or facility. We will discuss the most important points about Medicare Part B in this article.
Medicare Part A - Hospital Insurance
Medicare Part A is the hospital insurance for Medicare. It provides any medically necessary visits to the hospital. Most people are automatically enrolled in Medicare Part A within three months of turning 65.Some, however, are not. We will go over enrollment, coverage, price, and other issues in this article.
Medicare Part D
Medicare Part D is the latest addition to Medicare. It provides prescription drug benefits to all who enroll. Part D enrollment is not automatic. You must enroll according to Medicare’s guidelines and pay all fees as discussed below.
How Medicare Part D works. In order to receive Part D benefits you must enroll in a PDP (prescription drug plan) through a private insurance company that offers Medicare-approved plans. Anyone eligible for Medicare Part A or who is currently enrolled in Medicare Part B is eligible for Medicare Part D.
Penalty for not enrolling. If you do not enroll the immediate month that you become eligible then you will be forced to pay a penalty. You become eligible the month that you enroll in Part A or Part B Medicare. For each month then on that you do not enroll you will be penalized 1% per month. Thus, hypothetically, if you waited 32 months after enrolling in either Part A or B you would have to pay an additional 32% on top of your premium permanently.
There are ways to avoid this hefty penalty. If you have a health insurance from your employer that provides prescription drugs that are similar to what you're provided under Part D then you will not be subject to the penalty. This is called “creditable prescription drug coverage”. Another strategy to avoid the penalty is simply to enroll in a low-premium, cheap PDP. You can always change it later if need be.
Durable Medical Equipment
Durable medical equipment refers to things like canes, wheelchairs, hospital beds (for home use), diabetic testing equipment, oxygen tanks, walkers, and so forth. Durable medical equipment is usually related to and necessitated by your medical condition.
Medicare Advantage
Medicare Part C is also called Medicare Advantage. Part C combines Medicare with traditional health care insurance. Medicare Part C is run by an insurance company and has the feel of an insurance company rather than a government program. Let’s go into the specifics of Medicare Advantage.
What is Medicare?
Medicare is a complex government program administered by the CMS (Center for Medicaid & Medicare Services) and the Social Security Administration. The program is meant to provide a safety net for seniors.
Eligibility. There are two types of Medicare eligibility: free coverage and paid coverage. If you qualify, you are automatically enrolled in the free coverage.
Basics of Home Health Care
Medicare Part A and Part B provide for some services outside of a hospital or your doctor’s office, such as a skilled nursing home. We will focus on one of those services: home health care.
What is home health care? Home health care provides services for patients who do not require care from highly trained nurses and doctors in the skilled nursing facility or hospital setting. They may, however, require part-time care, physical therapy, or other services such as bathing, cleaning, cooking etc. Home health care agencies are a cheaper alternative.
What are the requirements? First, you must be under the care of a doctor who recommends and designs a home health care plan. He must also review it from time to time. He must also certify that you need some type of therapy (e.g. physical or occupational therapy) and that you need periodic skilled nursing care.
Second, you must select a home health care agency that is certified by Medicare. You can get a list of those at this website. Finally, you must actually be home bound. If you’re capable of leaving your house to receive care than home health care is not medically necessary for you.
Medigap & Medicare Supplement Insurance
Medicare is a safety-net program provided by the United States government. It is funded by your payroll taxes. You may be surprised, however, to learn that Medicare will not cover all of your medical expenses.
When you turn 65 years old, you are automatically enrolled in Medicare Part A. This is basically hospital insurance. You can voluntarily enroll in Part B, which is the medical insurance portion of Medicare but you will have to pay a premium and other fees just like any other health insurance.
There are many health care costs that will not be covered by either Medicare Part A or B. For example, if you are hospitalized you will have to pay the first three pints of blood if you need a transfusion or for any TV and food costs associated with your hospital stay. What can be especially costly is the how many days of hospitalization Medicare will pay for you. You are limited by a 190 day period. Once your stay is more than 190 days you will have to begin paying a daily premium that is upwards of $150. Unless the 190 day period is separated by a 60 day period of non-hospitalization then you will pay the premium. This 190 day period is called a “benefit period”.
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