A Summary of: Medicare Parts A, B, C & D 

Medicare changes have been enacted into law. The new benefit regulations are often complicated and not easy to understand. Medicare is made up of these parts:

Part-A: covers hospital care and most hospital charges for the first 60-days for in-patient care after the deductible of: $1,068.00. The next 30-days are also covered each year after a daily co-insurance payment of: $267.00 per day, up to: $8,010.00 has been made by you. For catastrophic situations, there is an additional benefit of 60-reserve days of coverage. Those extra 60-days are a once in a lifetime reserve, are not renewable, and have a daily co-insurance payment of: $534.00, up to $32,040.00 paid by you.

Medical care you receive in a skilled nursing facility is covered for a limited period of time. Medicare covers the first 20-days 100% and the next 80-days all but a daily co-payment of $133.50 a day, up to $10,680.00 to be paid by you. Medicare does not cover custodial care, like eating, dressing, transferring, continence, bathing and toileting, also known as Long Term Care.

Part-B: covers doctor visits, surgery and outpatient care and is optional. It does have a monthly cost of: $96.50, which will be deducted from your Social Security payments each month. Part-B covers up to 80% of your outpatient services at the Medicare approved rate. Medicare approved amounts may be considerably less than the actual billed amounts, but cannot be more than 115% more than the Medicare approved amounts. Skilled home care is very limited in the scope of services that Medicare provides, but would also be covered at 80%. Medicare does not cover in-home custodial care, also known as Long Term Care.

Part-C: This is an option to replace Original Medicare Parts A & B and is known as Medicare Advantage Plans or MA. These plans are part of the Medicare program but a private company instead of Medicare will provide benefits. Private companies pay your health providers instead of Medicare. Monthly costs for you may be less than original Medicare and a Medi-gap policy, but out of pocket, co-payments and co-insurance when you have a claim may be substantially more. MA Plans may offer extra benefits such as vision and hearing and may or may not include prescription drug coverage. MA is available in two versions HMO’s and PFFS, Private-Fee-For-Services. Medicare will no longer provide your benefits if you enroll in any of the MA Plans. Each plan has a different mix of costs and benefits. Enrollment periods are limited to Nov. 15^th - Dec. 31^st & Jan. 1^st - Mar. 31^st. No changes can be made during the remainder of the year, so make sure you chose a plan that will meet your needs.

Part-D: This provides prescription drug coverage and is administrated by private insurance plans. You can join a Prescription Drug Plan (PDP) three months before you turn age-65, the month you turn 65 and the three months after. If you have Medicare, you are eligible for Part-D. A government-imposed penalty will apply if you do not enroll when initially eligible. The cost for a PDP will vary from plan to plan as will coverage benefits and formulary definitions.

The basic benefits are common to all plans. There is an annual deductible of: $265.00. After the deductible is met the next $2,700.00 are covered. You will have a co-payment for each prescription that will vary by plan. After that you will be responsible for all costs until $4,350.00 of annual expenses are met which is referred to as the “doughnut-hole”. After the doughnut-hole expenses are met, you are considered to have “catastrophic coverage” and you will only have to pay a co-payment.

Medicaid: is a joint Federal & State program that helps with medical costs for people with low incomes & limited resources. Most healthcare & insurance costs are covered if you qualify for both Medicare & Medicaid. Programs and qualifications vary from state to state, but are limited to people within 200% of the poverty level.

Medicare Enrollment: You are automatically enrolled in Part-A if you are collecting Social Security. As you are approaching age-65, you can enroll in Medicare Parts A & B, as well as any supplemental plans, known as Medi-gap Insurance 6-months before your 65th birthday. Parts B & D have costs and therefore have to be elected to receive coverage. Enrollment can be done through your local Social Security office. You can enroll in Part D, online and information about all plans are available at: www.medicare.gov.

Medi-gap Plans: For expenses that Medicare does not cover, there is private Medi-gap insurance called Medicare Supplement polices. They pay for medical bills for the portion that Medicare Parts A & B do not cover. There are 12 standardized plans that will pay benefits directly to your heath care providers after Medicare has paid their portion of the approved charges. The basic benefits are the same in all plans but it is important to understand the different coverage's, co-payments and/or deductibles you could be responsible for with each plan. The good thing is you can compare apples to apples, as the benefits in Plan-C for example are the same no matter which company you choose. The main criteria for choosing are how much it costs and how good the service is from the company you are selecting. I have a database with all companies and plans available in NC and provide a no cost review to make sure you are getting the best coverage for your dollars, so call today: 888-489-2590 

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Contact us today for a no cost, no obligation, no pressure assessment of your health benefit situation. With our resources we might be able to save you money or get you more benefits!