This is the final part of a three-part series on Medicare. The first two parts can be viewed here and here.

HE SAYS:

Medicare, Part C is, collectively, Medicare Advantage Plans (like an HMO or PPO) that are sold by private insurance companies that are approved by Medicare.  These Plans combine Part A and Part B coverage.  In most cases, Part C plans are a lower cost alternative to the Original Medicare Plan and usually provides extra benefits and includes prescription drug coverage.

Medicare, Part D is the prescription drug coverage insurance that is provided by private companies approved by Medicare.   Much like Part B, you need to enroll when you first become eligible to keep from paying a penalty cost later.

There are two ways to join the Medicare prescription drug plan.   The first is by adding it to your Original Medicare Plan (Part A) as a stand-alone coverage or as part of an approved Medicare Advantage Plan you purchase from a private insurance company such as an HMO or PPO plan (Medicare, Part C) that includes Part D coverage.   If you add it to the Original Medicare Plan, you will pay a separate fee or yearly deductible.  Most Part C private plans already include the prescription drug coverage.

This is the standard Part D drug prescription plan for 2011 measured as a yearly benefit period required by Medicare:

A.  You may be required to pay the first $310.00 of your drug costs as your yearly deductible.

B.  You then pay a co-payment until your co-payments and the portion paid by Medicare reaches a total of $2,840.00.

C.  Once you reach $2,840.00 you are in the coverage gap (or what is now famously known as the “donut hole”).   Previously, you had to pay the full cost of your prescription drugs during this gap; however, starting in 2011, you receive a 50% discount on covered brand name prescription medications.   The intent is that by 2020, the gap will be fully closed and you will only pay your co-payment.

D.  Once your out-of-pocket costs, including your deductible and co-payments, reach a total of $4,550.00 your coverage gap ends and Medicare will then pay most of the costs of your prescription medication for the remainder of the year.

There are many decisions to make when entering the world of Medicare and you should explore all of your options so that so are ready to make your choices when you turn 65.

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This is the second part of a three-part series on Medicare.

HE SAYS:

Unlike Part A, Medicare, Part B is elective and is not free.  You pay a monthly premium which may change on January 1st of each year.   The monthly premium for 2011 is $110.50 unless your annual income is over $85,000 for individuals or $170,000 for couples.   The monthly premium may be even higher if you did not choose Part B when you first became eligible at age 65.   In fact, the cost of Part B may go up 10% for each twelve month period that you could have had Part B but did not sign up for it.

You can sign up for Part B any time during a 7 month period that begins 3 months before you turn 65.   If you choose to have Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payments.   If you do not receive any of these retirement payments, Medicare will bill you for the premiums.

Medicare, Part B, helps pay for Doctor’s services; outpatient medical and surgical services and supplies; diagnostic tests; ambulatory surgery center facility fees for approved procedures; durable medical equipment such as wheelchairs, hospital beds, oxygen, and walkers; and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home health care, when these services are medically necessary.  Medicare, Part B, does not pay for prescription drugs, cosmetic surgery, and routine physical exams.

You may go to any Doctor or hospital that accepts Medicare and a fee is charged each time you receive a service.   Medicare pays its portion of the fee and you pay the balance of the fee.   If you go to a Doctor or hospital that does not accept Medicare, you will have to pay the full charge and Medicare will send you its share of the costs.

The portion paid by Medicare, Part B, is measured by a Benefit Period which is based on a calendar year.  The portion not paid by Medicare, Part B, is paid by you as a deductible.   The Medicare, Part B, deductibles for 2011 are as follows:

1.  Medical and other Services: Once each calendar year, you pay a deductible of $162.00 and, then, 20% of all Medicare approved amounts after the deductible.

2.  Outpatient Hospital Services: You pay a co-insurance or fixed co-payment which may vary according to the service, but never higher than the Part A deductible of $1,132.00.

3.  Home Health Care: You pay nothing for Medicare approved services, if you meet certain conditions established by Medicare.

4.  Durable Medical Equipment: You pay 20% of the Medicare approved amount.

5.  Outpatient physical and occupational therapy: You pay 20% of all costs.

6.  Most Diagnostic Tests: You pay 20% of the cost after the $162.00 deductible.

One important right you have with both Medicare, Part A and Part B, is that you can obtain emergency care when and where you need it.   You do not need approval from your health plan.   If you think your health is in serious danger because you have severe pain, a bad injury, sudden illness, or an illness quickly gets worse, you can get emergency care anywhere in the United States.

The next installment will be about Medicare, Part C and Part D.

WHAT DO YOU SAY?

Today we present the first part of a three-part series on Medicare. It will run on Mondays.

HE SAYS:

We all realize that as we age not only does the risk of illness increase; but, also, we must face the prospect of increasing health care expenses.   With this in mind, the Federal Government created the Medicare Program in an effort to help with the health care expenses we will all face as we grow older.

Medicare, Part A, also known as the Original Medicare Plan or “fee-for-service”, is automatically available to you, without cost, when you turn 65 years old if you or your spouse worked and paid Medicare taxes.   If you or your spouse did not pay Medicare taxes while working, you still may be able to buy Part A coverage when you turn 65 years old.

Medicare, Part A, helps pay for care in hospitals as an inpatient, critical access hospitals, skilled nursing facilities, hospice care, and some home health care.  You may go to any hospital that accepts Medicare and a fee is charged each time you receive a service.   Medicare pays its portion of the fee and you pay the balance of the fee.

Medicare, Part A, helps pay for hospital stays in a semi-private room and includes, general nursing and other hospital services and supplies.  It does not cover private duty nursing, telephone or television expenses or a private room, unless medically necessary.

The portion paid by Medicare, Part A, is measured by a Benefit Period which begins on the first day you receive services as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any facility for 60 days in a row.  

The portion not paid by Medicare, Part A, is paid by you as a deductible.   The Medicare, Part A, deductibles for 2011 are as follows:

1.  Hospitalizations:  During any Benefit Period, you pay $1,132.00 for the first 60 days; $283.00 per day for the 61st through 90th day; $566.00 per day for the 91st through 150th day; and all of the expenses after the 150th day.

2.  Skilled Nursing Facility Care: During any Benefit Period, you pay none of the approved expenses for the first 20 days; $141.50 per day for the 21st through 100th day; and all of the expenses after the 100th day.   You must meet Medicare’s requirements, including having been in a hospital for at least three days and entered a Medicare approved facility within thirty days after leaving the hospital.

3.  Hospice Care:   As long as your doctor certifies that you are terminally ill and you elect to receive these services, you pay none of the approved expenses, except for a very limited co-insurance for outpatient drugs and inpatient respite care.

As you can see, even though helpful, Medicare, Part A, still leaves you with potentially devastating health care costs if you are ill and hospitalized for any length of time.

In the next installment we will outline the benefits of Medicare, Part B.

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