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Medicare Explained

 


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Medicare is health and hospitalization insurance for people older than 65 or for those who are disabled. Some portions of Medicare are not free, however, and premiums are deducted from your Social Security benefit checks. Even if you have private insurance you should apply for Medicare. If you don't you may end up paying higher premiums later.

There are three levels of Medicare coverage available.

Medicare Part A - hospital insurance
Part A Medicare is provided at no charge to anyone disabled or over the age of 65 who has paid Medicare taxes for at least 10 years. It covers the hospitalization costs, over and above your deductible, for the first 60 days of your hospital stay. From there, Medicare pays all costs above your co-pay until the 90th day in the hospital.

If you were in the hospital for at least three days, Medicare Part A will cover the approved costs of your stay in a nursing home for the first 20 days of care. After that, it pays for all costs over your co-insurance payments up to the 100th day.

Blood transfusions are also covered by Medicare, after the first three pints of blood.

If it is determined that your condition is incurable and you would prefer not to stay in a hospital, Medicare will pay for hospice care, with limits on outpatient drugs and inpatient respite care. Hospice care provides a more comfort-based approach, preferring support, therapy and pain-killing drugs to surgery, hospitalization and traditional medicine.

Home health care as well as 80 percent of medical equipment costs are also covered by Medicare.

Medicare Part B - doctor, outpatient and clinical services
To obtain Medicare Part B coverage, you must pay a premium of about $54 a month. This coverage pays for 80% of approved doctor and outpatient services. You will be responsible for the remaining 20%. Be aware, however, that not all doctors accept Medicare. Check with your doctor before you receive services. Medicare Part B also covers medical tests, lab work, biopsies, and blood work as well as blood transfusions after the first three pints, home medical care and 80% of the cost of home medical equipment. If you don't enroll in Part B at the time you turn 65, you can enroll later, but for each year you put it off the premium will increase 10%.

Medigap is supplemental private insurance that will pay for any costs not covered by Medicare Plan B. If you don't sign up for Medigap at age 65, you can enroll later, but you will be subject to underwriting, which may be a problem if you are in poor health or have chronic conditions. Signing up at age 65 is your best bet. That way, you are guaranteed to get the insurance at the lowest cost, and no one can take it away.

Medicare Part C - Medicare Plus Choice
Medicare Part C is the newest offering from Medicare. It's a private plan under which plan members receive all the benefits of Medicare Part A and B as well as their choice of the following: an HMO (Health Maintenance Organization), a PPO (Preferred Provider Organization), a PSO (Provider Sponsored Organization), a MSA (Medical Savings Account) or another private fee-for-service plan.

What's not covered by Medicare?
While Medicare does cover a substantial amount of healthcare costs, there are quite a few things that is does not cover. For these costs, private insurance can pick up where Medicare leaves off.

Examples of unpaid costs:

  • Nursing Care beyond 100 days
  • Medical Services in foreign countries
  • Doctors who have not joined the Medicare plan
  • Prescription drugs outside a hospital
  • Regular check-ups
  • Cosmetic surgery
  • Immunizations

Medicaid
For people living in poverty, Medicaid will assist with medical and health care bills. Medicaid is administered by the states, and in many states it is called something other than Medicaid. To qualify for Medicaid, household income must be less than a certain low amount with an additional allowance for each additional family member. Medicaid support is meant to be a last resort for those who can't afford health care. 

 


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