Medicare Supplement
Medicare Frequently Asked Questions
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How Medicare Works
Centers For Medicare and Medicaid Services 2013 Guide to Medicare
Medicare is the federal health
insurance program for people over 65 years of age and people with
certain disabilities or End-Stage Renal Disease (permanent kidney
failure). There are four parts to Medicare:
- Part A – Hospital Insurance
- Part B – Optional Medical Insurance
- Part C – Optional Medicare Advantage Insurance
- Part D – Optional Prescription Drug Insurance
2013 Medicare Part A
Helps pay
for care in hospitals, some skilled nursing facilities, hospice, and
some health care. For most people,
Part A is premium-free because they paid Medicare taxes.
| Hospitalized | Medicare Covers | Individuals Pay |
| 1-60 days | Most confinement costs after the required Medicare Deductible. | $1,184 Deductible |
| 61-90 days | All eligible expenses, after the patient pays a per-day co-payment. |
$296 per Day Co-payment |
| 91-150 days | All eligible expenses except per-day co-payment. 60 Lifetime Reserve Days may not be reused. |
$592 per Day
Co-payment |
| 151 days or more | Nothing | 100% |
| Skilled Nursing Confinement Must be receiving skilled nursing care in a Medicare approved skilled nursing facility that begins within 30 days after hospitalization of at least 3 days. |
All eligible expenses for the first 20 days; then all eligible expenses for days 21-100, after patient pays a per-day co-payment. | $148.00 per-day Co-payment days 21-100. All costs after 150 days |
Optional coverage to help pay for doctors, outpatient hospital care, and some other medical services not covered by Part A. The chart below shows the Part B monthly premium amounts based on income. These amounts change each year. There may be a late-enrollment penalty.
| If Yearly Income is | Individual Pays | |
|
Single Individual Return |
Married Joint Return |
A late fee is possible |
| $85,000 or less | $170,000 or less | $104.90 |
| $85,000 - $107,000 | $170,000 - $214,000 | $146.90 |
| $107,000 - $160,000 | $214,001 - $320,000 | $209.80 |
| $160,000 - $214,000 | $320,001 - $428,000 | $272.70 |
| Above $214,000 | Above $428,000 | $335.70 |
Medicare General Enrollment Period is from January 1 through March 31 of each year at a Social Security Administration office. Part B coverage will start on July 1 of that year.
Special Part B Enrollment Periods - while covered by employer or union group health plan or within 63 days of the date when the employer or union group health plan coverage ends, or when employment ends.
| Expense | Medicare Covers | Individuals Pay |
| Medical
Expenses Physician's services for inpatient and outpatient medical/surgical services; physical/speed therapy, diagnostic tests |
80% of approved amount | $147 Deductible plus 20% of approved amount |
| Clinical Laboratory Services Blood tests, urinalysis |
Generally 100% of approved amount | Nothing for services |
| Home Health Care Part-time or intermittent skilled care, home health aide services, durable medical supplies and other services |
100% of approved amount; 80% of approved amount for durable medical equipment | Nothing for services; 20% of approved amount for durable medical equipment |
|
Hospital Outpatient Hospital services for the diagnosis or treatment of an illness or injury |
Medicare payment to hospital, based on outpatient procedure payment rates | Coinsurance based on outpatient payment rates |
| Blood | After first 3 pints of blood, 80% of approved amount | First 3 pints plus 20% of approved amount for additional pints |
Part C Optional Medicare Advantage Plan Monthly
An alternative to traditional Medicare, Part
C is another way to get Medicare benefits. It combines Part A, Part B,
and, sometimes, Part D (prescription drug) coverage. Medicare Advantage
Plans are managed by private insurance companies approved by Medicare.
These plans must cover medically-necessary services. However, plans can
charge different copayments, coinsurance, or deductibles for these
services.
Part D Optional Medicare Prescription Drug Plan
This optional coverage may help lower an
individual's prescription drug costs and help protect against higher costs in the
future.