Medicare Part A: Hospital Coverage (Inpatient)
Hospital Inpatient Care: You’re admitted to the hospital after an official doctor’s order, which says you need inpatient hospital care to treat your illness or injury. Medicare Part A will pay for all medically necessary services while in the hospital. The Part A deductible is $1,556 for 2022. Medicare Supplement Plans cover the deductible.
Skilled Nursing Facility/Rehab and Recovery Care: To qualify for care in a Skilled Nursing Facility, you must have been an inpatient in a hospital for three or more consecutive days. The discharge day cannot be the third day. Medicare pays all costs for the first 20 days. For days 21-100 in a Skilled Nursing Facility Medicare has a daily copay of $194.50. Medicare Supplement Plans cover the daily copays.
Hospice Care: To be eligible for Medicare’s hospice benefit, your doctor must certify you are terminally ill with a life expectancy of six months or less. You accept comfort care (palliative care) instead of care to cure your illness. Medicare-certified hospice care is usually given in your home or other facility where you live, like a nursing home. You can also get hospice care in an inpatient hospice facility. You pay nothing for hospice care.
Home Health Care: These are medically necessary services that a doctor must order. Your doctor must certify that you’re unable to leave your home without some difficulty; in other words, you’re homebound. Physical, speech and occupational therapy can be done in the home. Medicare does not pay for 24-hour care at your home or meals to be delivered to your home. Medicare will not pay for homemaker services such as cooking, cleaning, and shopping or if you need ongoing help with personal care services such as dressing, bathing, and toileting. Medicare will cover all costs for Medicare-approved home health care.
Part A is free if you have worked the required amount of time, generally ten years or 40 quarters, and paid Medicare taxes while working.
Medicare Part B: Medical Insurance (Outpatient)
Part B of Medicare provides Outpatient medical services. You can receive these outpatient medical services and treatments at a doctor’s office, hospital, or clinic. There is an annual deductible of $233 for Part B medical services, and after the deductible is met, Medicare only covers 80% of Part B medical expenses. Without a Medicare Supplement, you are responsible for 20% coinsurance. Medicare Supplement Plans cover the 20% coinsurance. The following is a list of outpatient medical services and treatments that require 20% coinsurance.
Doctor’s office exam
Diagnostic testing and Lab tests
Chemotherapy and Radiation treatments
Physical, speech, and occupational therapy
Durable medical equipment
Drugs administered in a doctor’s office
Mental health services
You pay a monthly premium to the government for your Part B coverage. The standard Part B premium for 2022 is $170.10. If your income exceeds a certain amount, your premium could be higher than the standard premium.
Medicare Part C: Medicare Managed Care Plans
Part C of Medicare refers to Medicare Advantage Plans (MA Plans). These managed care plans are offered by private insurance companies approved by the Center for Medicare and Medicaid Services. Medicare Advantage Plans are not considered supplemental Medicare coverage. Medicare pays a fixed amount for your care every month to insurance companies offering Medicare Advantage Plans. Advantage Plans must provide the same benefits as Original Medicare (those covered under Parts A and B); however, each plan can charge different out-of-pocket costs and have different rules for how you get services. They can require pre-authorization for medical care, referral before seeing a specialist, and go to doctors and hospitals in their network. If you want to see doctors outside of the network, you could pay considerably more in out-of-pocket costs. If you enroll in an Advantage Plan, you must continue to pay the Medicare Part B premium of $170.10.
Medicare Advantage Plans are growing in popularity because many of them have a zero monthly premium and include benefits for dental, vision, and hearing. Should you consider enrolling in a Medicare Advantage Plan? Yes, if your are on a limited income. Even though many of these MA Plans have a zero monthly premium it does not mean that medical services will end up costing you zero. You could incur substantial out-of-pocket costs for inpatient hospital care, cancer treatments (radiation and chemo), kidney dialysis, durable medical equipment, prosthetics, and drugs administered in a doctor’s office. It is a fact of life the older you get the more medical services you will need. Don’t base your decision to enroll in a MA Plan because it has a zero monthly premium, or because it offers dental coverage. When you go on Medicare at age 65 or older you are going to end up using your health insurance more and more. Get all the facts, compare plans, and choose wisely before you enroll in a Medicare health plan.
Medicare Part D: Prescription Drug Coverage
Part D of Medicare is the prescription drug benefit that covers outpatient prescription drugs. Part D is offered by private companies that have contracts with the government to provide this coverage. You pay a monthly premium to an insurance company for your Part D plan. You will have an annual deductible to meet and have to pay a copay or a percentage of the drug’s cost. Each Medicare prescription drug plan has a list of covered drugs, called its formulary.
Medicare drug plans place medications in their formulary that are placed in Tiers 1-5. The lower the tier, the less you pay for the medication. Brand name medications that are not available in generic can be expensive with a Medicare drug plan. It would be best to enroll in a Part D prescription drug plan when you first go on Medicare or lose your employer coverage. If you delay enrollment, you will have to pay a late enrollment penalty and have gaps in your coverage.