MEDICARE BASICS (The ABC’s and D)
Understanding the basics of Medicare can be overwhelming. The most common misconception is that Medicare pays for all senior care and senior living housing. Let’s break it down into smaller pieces to understand what’s covered and what’s not.
Part A is your hospital coverage. This coverage pays for your room and board in the hospital or skilled nursing facility. Part A also pays for Hospice.
- Medicare pays for your first 60 days in the hospital. You will have a hospital deductible which will be $1484 for 2021.
- Medicare pays for your skilled nursing stay after you’ve met the three-night qualifying inpatient stay (three consecutive midnights) **up to 100 days.
- Once you meet the three-night inpatient stay, Medicare will pay for the first 20 days in full of your stay on a transitional care unit (TCU or rehab unit) at a skilled nursing facility.
- Days 21 through 100, you will be responsible for a co-pay. **For Medicare to pay for any days in a skilled nursing facility, you must need daily skilled services provided by a registered nurse or therapist (Physical, Occupational or Speech Therapist).
Part B is your Outpatient Coverage. This includes doctor visits, durable medical equipment, lab work, surgeries, diagnostic tests, hospital beds, home dialysis equipment, parenteral and enteral feeding systems, wheelchairs, scooters, CPAP devices and prosthetics, orthotics and supplies when they are:
- Durable (able to withstand repeated use)
- Customarily and primarily used to serve a medical purpose
- Generally, not useful in the absence of an illness or injury
- Appropriate for use in a beneficiary’s home, relative’s home, or home for the aged (excludes skilled nursing facilities).
Medicare Advantage Plans are an alternative to Original Medicare. Medicare Advantage plans enable beneficiaries to receive their Medicare benefits through one of several types of private health plans.
- Generally available throughout the county
- Most offer Part D prescription drug plans
- Many Medicare Advantage plans provide benefits that Original Medicare does not provide, such as dental and vision checkups and annual physical exams.
Part D is your Drug Coverage and is a voluntary program in which private insurance companies’ contract with Medicare as stand-alone prescription drug plans or as Medicare Advantage plans with the prescription drug benefit.
- Premiums for Part D vary widely – from less than $10 to almost $200 per month; and those with higher incomes pay an additional amount based on their income.
- Medicare’s standard drug benefit has four levels, also called benefit phases:
- The deductible
- Initial Coverage
- Coverage gap (aka “donut hole”)
- Catastrophic Coverage
Trying to navigate Medicare is not easy. Thankfully, you can reach out to the Senior Linkage Line for additional support, guidance, and knowledge. Just ask for a Medicare Specialist! You can reach the Senior Linkage Line at 1-800-333-2433