Supplementing Medicare with peace of mind
MEDICARE BASICS
Original Medicare is divided into two parts, Part A (hospital insurance) and Part B (medical insurance). Medicare Part A covers catastrophic circumstances that result in hospitalization. This plan also provides some coverage for skilled nursing facilities, hospice care and home health, in certain circumstances. These are important components of healthcare for mature adults. Medicare Part A normally has a $0 premium; however, immigrants, naturalized citizens or those who have not worked in the United States are responsible for a monthly premium to buy into Medicare Part A coverage. Beneficiaries qualify for Medicare Part A through "40 quarters" of employment or by the employment of a spouse.
Part B covers supplies and services required to treat and diagnose medical conditions, if Medicare deems such treatment to be medically necessary. It also covers some preventive health care. However, preventive services are only covered, if your healthcare provider accepts assignment. Part B monthly premiums are determined on a sliding income scale. The premiums are usually deducted from the beneficiary's monthly Social Security benefit.
Medicare
Coverage Options
A private company contracts with Medicare to provide Medicare Part A for hospital insurance, and Medicare Part B for medical insurance. Medicare options include Original Medicare, Medicare Advantage Plans and other Medicare health plans. If you're older than 65 or turning 65 in the next three months and not already receiving Social Security benefits, enrollment in Medicare Part A and Part B are not automatic. You must apply to receive the benefits. If you are already a Social Security recipient, enrollment in Medicare Part A and Part B will occur automatically upon meeting eligibility requirements.
Original Medicare is available to every beneficiary who qualifies for Part A and Part B of Medicare through employment. Upon qualifying for Original Medicare at age 65 or by a qualified disability before age 65, a beneficiary is responsible for the approved portion of claims not covered by Medicare Part A or Part B.
There are two elections to cover the gaps in Medicare coverage: 1. Purchase a Medicare Supplement Plan, and a prescription drug policy (Medicare Part D) or 2. Transition to Medicare Part C a (Medicare Advantage Plan), which includes Part A, Part B and Part D "coverage". A qualified advisor can help you understand the different Medicare benefits and assist you with the application process.
Medicare Part A
Medicare Part A enrollment is automatic upon application for Medicare. It is designed to cover hospital stays, hospice care and skilled nursing care that might be necessary for rehabilitation. When hardworking Americans pay Medicare tax out of their salary, Medicare Part A does not have a premium at age 65. However, the Medicare Part A benefit is not free. The inpatient hospital deductible is approximately $1,400, (and is a constantly changing variable) in the Medicare equation. For this reason, supplementing Medicare becomes necessary for millions of Americans. A Medigap policy can be the needed solution to cover deductibles and other costs. For all the gaps in coverage and for help covering the unpaid costs, a Medicare supplement plan is available all year long, through private insurance companies.
Medicare Part A Coverage
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Inpatient care (in a hospital)
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Skilled nursing (facility) care
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Nursing home care (not custodial or long term care)
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Hospice care
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Home health care
Neither Medicare Part A or Part B covers:
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Custodial Care
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Most dental care
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Eye exams (for prescription lenses)
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Dentures
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Cosmetic surgery
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Acupuncture
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Hearing aids and exams
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Routine foot care
MEDICARE PART B
Medicare Part B covers clinical research, ambulance services, inpatient and outpatient mental health, partial hospitalization, durable medical equipment, and limited outpatient prescription drugs. Under certain circumstances, you could have a medical need for treatment or services that is deemed not medically necessary and therefore not covered by Medicare Part B. It is important to talk to your physician and health care professionals about the services you require, to identify your unique needs related to covered services.
Medicare Part B covers certain drugs which are administered by injection, durable medical equipment, such as: an infusion pump or nebulizer, injectable medications for females suffering with osteoporosis, (provided certain criteria is met), erythropoietin injections, if you suffer end-stage renal disease or anemia related to certain conditions and blood clotting factors, most injectable and infused medications.
Medicare Part B is designed to cover medical office visits with your practitioner, specific lab tests, diagnostic screenings, certain medically necessary medical equipment, many outpatient services and ambulance transportation services.
Medicare Part B Coverage
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Medically necessary services (diagnostic and treatment)
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Preventative services (flu and other vaccinations)
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Clinical research
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Ambulance services
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Durable medical equipment
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Mental health (inpatient, outpatient and partial hospitalization)
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Medical screening
Enrolling in Medicare Part B
Just as with any health plan, there is an optimum time for enrollment. Your circumstances will determine what is right for you. If you have health insurance through a spouse or employment, you might consider delaying enrollment due to the cost of premiums. However, if you lack insurance coverage, delaying your enrollment in Medicare Part B can result in paying a higher premium for the duration of your enrollment in the plan.
The initial enrollment period begins for beneficiaries aging into Medicare 3 months prior to the month of their 65th birthday. The initial enrollment period continues through their birth month and concludes 3 months after turning 65. During the initial enrollment period, a beneficiary can qualify for any Medicare Supplement policy without evidence of insurability. Once the period has concluded, medical underwriting would be required for most plans, as determined by state law or jurisdiction. A qualified advisor can help you understand available benefits, limitations, accessibility of Medicare insurance and the application process.
The Cost of Coverage
Monthly premiums are a variable amount determined by the federal government, and can differ if your income exceeds $87,000. Medicare Part B premiums are $144.60 for the year 2020. Still, the cost goes beyond the premium. There is an annual deductible of $198, plus 20 percent of the cost of all doctor visits and outpatient care. Plus, the monthly premiums, for Medicare Part B, are deducted from your monthly Social Security benefits, if applicable.
Medicare Part B helps pay for medical office visits with your practitioner, lab tests, diagnostic screenings, certain medically necessary medical equipment, outpatient services, some tests, supplies, out-patient surgical services, certain drugs which are administered by injection, durable medical equipment, and ambulance transportation services.