Medicare Breakdown

What is Medicare?

Medicare is a Federal health insurance program that pays for hospital and medical care for elderly and certain disabled Americans.

The program consists of two main parts for hospital and medical insurance (Part A and Part B) and two additional parts that provide flexibility and prescription drugs (Part C and Part D).

Part A – Hospital Insurance

Part A is hospital insurance that helps cover inpatient care in hospitals, skilled nursing facility, hospice, and home health care.

Covers

• Inpatient care in hospitals
• Inpatient care in a skilled nursing facility
• Hospice care services
• Inpatient care in a Religious Non medical Health Care Institution

*There is a deductible of $1,100 (2010)*

Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.

The Part A premium is $254.00 per month for people having 30-39 quarters of Medicare-covered employment.

The Part A premium is $461.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.

Part B – Medical Insurance

Part B helps cover medically-necessary services like doctors’ services, outpatient care, home health services, and other medical services.

Covers

• Durable medical equipment (canes, walkers, scooters, etc.)
• Physician and nursing services
• X-rays, laboratory and diagnostic tests
• Certain vaccinations
• Blood transfusions
• Renal dialysis
• Outpatient hospital procedures
• Some ambulance transportation
• Chemotherapy
• Certain hormonal treatments
• Prosthetic devices and eyeglasses*.

Part B requires a monthly premium $115.40 per month in 2011 and patients must meet an annual deductible  of $162.00 in 2011 before coverage actually begins. Also, there is roughly a 20% co-pay for services

What is NOT Covered by A & B

• Acupuncture.
• Deductibles, coinsurance, or copayments when you get health care services.
• Dental care and dentures (in most cases).
• Cosmetic surgery.
• Custodial care (help with bathing, dressing, using the bathroom and eating) at home or in a nursing home.
• Health care you get while traveling outside of the United States (except in limited cases).
• Hearing aids and hearing exams.
• Orthopedic shoes.
• Outpatient prescription drugs (with only a few exceptions).
• Routine foot care (with only a few exceptions).
• Routine eye care and most eyeglasses (exception for one pair of standard frames after cataract surgery with an intraocular lens).
• Routine or yearly physical exams.
• Certain screening tests
• Certain shots (vaccinations)

Supplemental – MediGap Plans

MediGap Policy fills in the gaps that A, B & D do not cover.  They usually will provide all of Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).

• Coverage provided by private companies that are approved and governed by Medicare.
• Each Plan can charge different out of pocket costs
• Each plan may have different rules for how you get services (like whether you need a referral to see a specialist or in network).

These rules can change each year.

Part D – Prescription Drugs

Annual subscription, fee based on what types of medications are covered and which plan chosen.

• Private insurers approved by Medicare that cover different types of medications, plan stays in effect for one year.
• If there is no plan available that covers medications needed then that cost has to be covered by paying out of pocket for it.
• If the plan happens to drop a covered medication after policy is in effect that policy is binding