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What is Medicare?

medicareMedicare is the traditional fee-for-service program offered directly through the federal government for people 65 and older. It has deductibles, co-insurance and out of pocket expenses, some with no caps. Medicare is divided into three parts – Part A (inpatient), Part B (outpatient), and Part D (prescription drug).

Medicare Part A helps pay for:

  • Inpatient hospital care for up to 90 days each benefit period, plus 60 lifetime reserve days in a general hospital.
  • Skilled nursing facility (SNF) care for up to 100 days each benefit period. To qualify, you must have been in the hospital for at least three consecutive days in the 30 days before admission and need skilled nursing services seven days a week, or physical, occupational or speech therapy services five days a week.
  • Home health care for up to 100 days. To qualify, you must have been in the hospital for at least three days in the 14 days before receiving care and be homebound.
  • Note: You can get coverage for home health care without a hospital stay through Medicare Part B.

  • Hospice Care for as long as your doctor certifies you need care. To qualify, a doctor must certify that you are terminally ill and have a life expectancy of six months or less.

Medicare Part B helps pay for:

  • Doctor services.
  • Durable medical equipment (DME) if your doctor certifies you need DME product and you buy or rent it from a Medicare-certified supplier.
  • Ambulance services if your health requires ambulance transport, and if you are traveling to or from certain locations.
  • Many preventive care services.
  • Outpatient physical, speech, and occupational therapy services provided by a Medicare-certified physical, speech, or occupational therapist.
  • Chiropractic care when manipulation of the spine is medically necessary to fix a subluxation of the spine.
  • Outpatient mental health services.
  • Home health services if and need skilled nursing or therapy services.
  • X-rays and lab tests.
  • A few prescription drugs, such as immune-suppressant drugs, some anti-cancer drugs, some anti-emetic drugs, some dialysis drugs and physician-administered drugs that persons do not usually administer themselves.

Medicare does not cover all health care services. Medicare will only pay for Part B services and items (except most prescription drugs) that are ordered or prescribed by a Medicare-enrolled provider.

Medicare’s drug benefit (Part D) is outpatient prescription drug coverage available for anyone with Medicare Parts A and B. Available through private companies, this optional coverage is only sold during approved enrollment periods. If you choose not to enroll and do not have creditable drug coverage from another source, you will incur a lifetime penalty of 1% for each month you were eligible for prescription drug coverage but chose not to enroll. People already enrolled in certain low-income assistance programs may be automatically enrolled in a Medicare drug plan and get financial assistance.

In order to better budget for the unknown, it is a good idea to have additional insurance to cover your out of pocket expenses. There are two types of plans available . . .

Medicare Supplement (Medigap). This type of plan works directly with Part A and Part B Medicare. You have the freedom to go to any doctor that accepts Medicare, at any time with no network restrictions or copays.

Medicare Advantage (Medicare Part C). These plans replace your original Medicare Part A and Part B. By law, they must offer at least the same benefits as Medicare, but, they are allowed to have different rules, costs, restrictions and networks you must adhere to.

Do your research and find the right plan for you. Everyone’s health, financial situations, and opinions on healthcare are different. Generally, people seek advice from relatives and neighbors, which is great. However, a trusted insurance advisor is the best. If you don’t have an insurance advisor, consider Healthcare Planners, Inc. We are knowledgeable and offer no hassle assistance, at no cost to you.

Years ago when I started HealthCare Planners, my business plan stated “HealthCare Planners desires to be a resource for people turning 65 and for seniors of all ages. We want you to be able to call us with a question and not feel like you’re trying to be sold something.”

Sometimes you just need an answer, and that’s okay with us. We’re all in this thing called life, together. We’ll help you any way we can. It’s our job and our life passion.