Editors note: A version of this column was first published in March 2013.
In my last column, I outlined how beneficiaries can begin receiving Medicare Part A and Part B. In this column, I will explain what they have, what both parts cover, what they cost, and what beneficiaries themselves can expect to pay.
Medicare Part A
Part A is free to nearly all seniors at age 65 and to those who have received Social Security disability benefits for 24 months because they or their spouses qualified for it by paying FICA taxes for at least 10 years. Part A basically covers stays in healthcare institutions, such as hospitals and skilled nursing facilities, as well as hospice and some home healthcare services.
For inpatient hospital care, Part A has a $1,316 deductible charge for each benefit period for the first 60 days of care. After 60 days, the copayment is $329 per day for the next 30 days. Additionally, each beneficiary receives 60 lifetime reserve days with a copayment of $658 per day, which can be used after the 90-day period noted above. A benefit period begins the day a patient is admitted as an inpatient in a hospital and ends when he has been out of the hospital for 60 days in a row. After this 60 days break, a new benefit period begins at the next hospital admission. The deductible applies for each benefit period, which could be several per year.
Medicare Part A also covers skilled nursing facilities, which are often used for rehab therapy, are free for the first 20 days, and cost $164.50 per day for the next 80 days.
Hospice care other than room and board is largely free or with minimum payments upon qualification. This care is reserved for terminally ill patients who are not expected to recover.
Medicare Part B
Beginning in 2017, Part B has a monthly premium of $109 for those who qualified for Medicare before 2017 and $134 for those qualifying this year. As usual, persons with an annual income of over $85,000 ($170,000 for a married couple) will pay more based upon income. Medicare beneficiaries who are removing savings from untaxed accounts like a 401(k) or IRA need to be aware that any untaxed money counts as income in the year it is withdrawn and can boost income into brackets requiring extra payment rates.
Medicare Part B has an annual deductible of $183 and a 20 percent coinsurance for most services thereafter. Part B covers visits to health care providers, durable medical equipment, lab work, most preventive services such as flu shots and cancer screenings like mammograms, an annual wellness visit, and emergency room services. In addition, Part B covers diabetes supplies such as test strips and a small number of drugs. Most self-administered drugs are covered by the Part D drug plans, which I will discuss in a future column.
There are private insurance plans – Medicare Supplement or Medigap policies – that can help pay for some or all Medicare approved services that Parts A and B do not cover in full. I will cover these plans as well as Medicare Advantage plans (Part C) in later columns.
It is important that Medicare beneficiaries receive care from providers who accept assignment to Medicare in order to pay the least for these services. Healthcare providers who do not accept assignment may charge patients a limited amount more for their services. Payment for any healthcare provider that does not accept Medicare at all becomes the responsibility of the patient.
Medicare does not cover long¬ term care in nursing homes or assisted living facilities, routine dental and eye care, dentures, and hearing aids.
Anyone needing help in signing up for Medicare or having questions regarding any aspect of Medicare can receive personalized assistance from the New River Valley Agency on Aging at 540-980-7720. The Virginia Insurance Counseling and Assistance Program (VICAP) at the Agency can help seniors find answers to specific Medicare questions.
Deena Flinchum is a retired IT professional who has lived in the New River Valley since 2002. She serves on the board of the NRV Agency on Aging and as an RSVP volunteer. She also serves the Agency on Aging as an insurance counselor.