There are many confusing rules and regulations for our seniors to follow when signing up for Medicare and/or the private plans, and the process can be overwhelming. It’s important for Medicare beneficiaries to understand all their options, what Medicare covers and, most importantly, what it doesn’t.
Original Medicare covers two parts; Part A is hospital coverage and Part B is medical coverage. Part A can be $0 premium if the beneficiary has worked for 10 years paying into Medicare taxes. It covers four things; inpatient hospital stays, skilled nursing, home health, and hospice. For 2019, if an individual goes in the hospital as an inpatient, they will have a $1,408 deductible for days 1-60. If the stay is past 60 days, now the beneficiary will look at $352 each day until day 90. Day 91 it goes up to $704 per day. It’s important to remember that the deductible is per benefit period, not per calendar year. For example, if an individual is admitted into the hospital at the beginning of the year, they will have to pay the $1,408 deductible. For example, if they go back six months later they will have to pay that deducible again.
Skilled nursing is covered for the first 20 days, but they are first required to be in the hospital for three nights. After 20 days, there’s a $176 copay per day in skilled nursing until day 100.
Home health care services that are deemed medically necessary such as therapy and skilled nursing, administration of medications, wound care, medical tests, etc. are covered 100% by Medicare. A doctor’s prescription is required, Medicare will not, however, cover help with cooking meals, cleaning your house, transportation, bathing, etc.
Hospice is covered 100% but can be subject to small copays for prescription medications and may charge 5% of the Medicare approved amount for inpatient respite care.
Original Medicare Part B has a monthly premium that reflects an individual’s income they reported two years ago. Anything medical is covered under Part B such as; doctor visits, outpatient surgery, emergency visits, urgent care, ambulance rides, blood tests, durable medical equipment, etc. Part B does have a yearly deductible, which is $198 for 2020. Once a beneficiary reaches the deductible, Medicare will cover 80% and the consumer is left with paying 20% of medical expenses.
Medicare does not have coverage for prescription medication, so it is always best to sign up for a separate plan to avoid a penalty. The penalty would be charged for each month that they didn’t have coverage from when they were first eligible. It wouldn’t affect them until they signed up for prescription drug coverage. At that point, they would pay the penalties on top of the plan’s premium for the rest of their life.
Medicare does not have a ceiling for out-of-pocket expenses. If the beneficiary had a catastrophic health year, the expenses could be life alternating. That is why it is important to speak with someone to go over their options to help elevate out-of-pocket expenses. With so many options out there today, it can be confusing which plan is best for you. At Informed Choice Insurance Agency, we are an independent company that can show all the options available. We are a salary-based agency that does not receive commissions. This gives our clients peace of mind when exploring options with an unbiased agent. If you ever have questions about your current plan or what other possibilities are out there, we are more than happy to assist you.
Andrea Munao, Sales Associate, Informed Choice Insurance Agency. Andrea lives in sunny Florida where she specializes in educating individuals who are Medicare eligible on plans including Medicare Supplements, Medicare Advantage plans and Prescription Drug plans. Andrea thrives on helping her clients understand the basics of Medicare and finding the best options available to them. Andrea can be reached at 239-208-7090 or email@example.com.