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Millions of people live with chronic disabilities. In the United States, almost 61 million American adults have a disability, according to the Centers for Disease Control and Prevention.
Depression isn’t just feeling sad, lonely or blue. It is a severe mood disorder that can have devastating consequences if left untreated.
We want to help you make the best decisions for your parents so we made it easier to understand what a Medicare Supplement plan is and what Medicare Advantage has to offer versus Original Medicare.
You should be especially mindful of your health insurance coverage if you are a diabetic or senior because you are at a high risk of developing more serious symptoms and complications from the coronavirus.
Many retirees and people with disabilities turn to Medicare and Medicaid to pay for their medical expenses, but these federal insurance plans can be confusing. What costs does each of these programs cover, and are there any fees associated with these programs?
Americans age 65 and over as well as disabled people and those with certain conditions are eligible for Medicare as their health insurance. Medicare was established in 1965 as a federal health insurance program that provides benefits to seniors, disabled people and those with certain end-stage illnesses.
Most people don’t know that there are really two versions of Medicare, the one that is managed by the federal government, often referred to as Original Medicare and Medicare Advantage, the private insurance program which has most of the same benefits of Original Medicare plus other coverages Original Medicare does not offer.
Unlike regular health insurance, with Medicare you can see any doctor, health care provider, hospital or facility that is enrolled in the Medicare program and accepts new patients. You do not need approval from a primary care physician to see a specialist but that specialist must be enrolled in Medicare.
With a few exceptions, most prescriptions aren’t covered in Original Medicare but they are with Medicare Advantage. Or you can add drug coverage, Prescription Drug Plan (Part D) by buying it from an agent who works for a private insurance company that is approved by Medicare.
You pay a monthly premium for Part B but never have to file Medicare claims. Providers and suppliers file your claims so there’s usually no paperwork on your part. This includes doctors, hospitals, nursing facilities and home health agencies.
Some people qualify for both Medicare and Medicaid. Medicaid is a health insurance program that provides coverage to eligible low-income adults, children, pregnant women, the elderly and people with disabilities. This program is jointly run by states and the federal government. Local governments administer this program according to federal guidelines and requirements. States determine the income-and-asset eligibility for their local Medicaid program. After a resident qualifies for the program, they can enroll.
The Medicaid program provides a wide range of health insurance coverage that includes lab tests, x-rays, medical transportation, doctor visits, hospital expenses, long-term stays in nursing homes, home health care services and other nurse practitioner services.
Medicaid also oversees the Medicare Savings Program that can help pay for expenses that Medicare doesn’t.
Medicaid provides coverage for long-term care costs in nursing homes and at-home care. Medicare doesn’t provide funding for long-term care facilities.
Prescription drugs are also not covered under the Medicare program, but if you qualify for the program, you can pay the premium for Medicare Part D, the prescription drug plan. Whether your doctor accepts Medicaid coverage varies. You should check with your provider to learn if they accept this coverage, especially when you see a specialist.
There is a deductible for Medicare, so you pay a set amount before Medicare begins to cover your costs. Even when coverage begins, you are required to pay a coinsurance/copayment for covered services and supplies. Unlike regular health insurance, there are no yearly limits for out-of-pocket expenses. You also pay a monthly premium for Medicare Part B.
Your out-of-pocket medical expenses depend on several factors. Most people have both Part A and Part B. If you don’t have both, you will have to pay more for services and supplies. Your expenses also depend on your health, the type of care you need and how often you need it. If you choose to get services or supplies that are not covered by Medicare, you will be fully responsible for payment(s). Your costs will also depend on whether or not you have other health insurance that works with Medicare, such as Medicare Supplement Insurance, also called Medigap.
People often think that Medicare is free, but that’s not true. Medicare Part A doesn’t have a premium like Part B, but there is a deductible that needs to be paid before expenses are covered. In 2017, the deductible was $1,316, which means that you have to pay that much out of pocket each benefit period before your medical expenses are covered by Medicare.
Parts B, C and D have a premium. Part B’s is estimated at $135 a month (2017) with an $183 deductible per year. After the deductible is paid, the Medicare recipient usually pays 20% of the Medicare-approved costs for covered services.
Medicare Part A is Hospital Insurance. It covers inpatient care in a hospital, skilled nursing facility, hospice care and some home health care costs. In 2017, the deductible was $1,316, which means that you have to pay that much out of pocket each benefit period before your medical expenses are covered by Medicare.
Medicare Part A usually doesn’t have a premium. It’s free, but Part B has a premium and deductible. If you don’t qualify for premium-free Part A, you can buy Part A for $458 a month (if you paid Medicare taxes for less than 30 quarters; for 30-39 quarters, it’s $252). In order to get Medicare Part A you must buy both Part A and Part B.
With Medicare, you’re qualified for care in a Skilled Nursing Facility (SNF) if you’ve been in the hospital for 3 days and still need care. Your Medicare Part A would, however, require a deductible, just under $1400, for the first 20 days of your stay. From days 21-100, you’d pay $167.50 per day out of pocket. After that period of time, there is no more coverage for a long-term facility stay and it’s all your personal expense.
Just as with Medicare, if you buy Medigap (from an agent) you’re covered by Medigap when you transfer to a nursing home only if you meet the 3-day minimum hospital stay. Only then would Medigap begin to cover your deductible and your coinsurance, if you need to stay more than 20 days but less than 100 days ($167.50 per day). Medigap will not cover you beyond 100 days. There is no coverage for indefinite nursing home stays.
Medicare Advantage plans are not standardized so you’ll have to check each plan and policy to get clear details on what’s covered and what’s not. Generally speaking, Medicare Advantage partially covers your stay (often without the mandatory 3-day hospital stay) but you’ll be charged a daily coinsurance. Like Original Medicare (with or without Medigap), long term care in a nursing facility or an indefinite stay beyond 100 days is not covered.
In most instances, the way Medicare decides if it will or will not cover a service when it comes to long-term care. Custodial care requires no medical training. It includes bathing, dressing and moving from seated to standing and to bed. Skilled care requires medical training and can not be done by a family member. However, even skilled care given by a nurse in the home or in a facility is also subject to a copay.
Medicare Part B is medical insurance. Part B covers doctors’ services, outpatient care, medical supplies and preventive services. If you don’t sign up for Part B when you’re first eligible you pay a late enrollment penalty fee for the duration of your coverage. Some people automatically get Medicare Part B and some people have to sign up.
Your premium for Part B is deducted from your benefit payment if you receive: Social Security, Railroad Retirement Board Benefits or Office of Personnel Management benefits. If you do not receive any of these benefits, you will receive a bill. The standard Part B premium amount in 2020 was $144.60 a month. However, if your modified adjusted gross income is above a certain amount, you may have to pay an Income Related Monthly Adjustment Amount on top of the premium.
The deductible for Part B in 2020 was $198. After that, Medicare recipients paid 20% of the Medicare-approved amounts for doctor services (in and out of hospital), outpatient therapy and durable medical equipment (DME).
For Medicare beneficiaries with an income below $87,000 for an individual or $170 per couple, the Part B premium cost for 2029 was an average $144.60 per month. For higher incomes, the price ranges from $189.60 to $460.50 per month.
Medicare Supplements are also called Medigap because they fill in the gaps in Original Medicare. These products are sold by private insurance companies and agents and pay for services and supplies not covered by Original Medicare. Covered costs include copayments, coinsurance and deductibles. However, as of 2020, Medigap plans aren’t allowed to cover the Part B deductible.
You must have Medicare Part A and Part B in order to buy Medicare Supplements. However, you cannot have Medicare Advantage and Medicare Supplements.
With Medicare Supplements you pay a private insurance company a monthly premium in addition to the Part B premium you have to pay. The policy only covers the insured. If you have a spouse, that person needs to buy a separate policy.
Medicare Supplement plans are guaranteed renewable even if you develop health problems as long as you are paying your premium. Medigap plans do not cover prescription drugs. For a drug plan, you can join Prescription Drug Plan Part D. Med supps do not cover long-term care vision or dental care, hearing aids, eyeglasses or private nurses.
You always have the option of changing a Medicare Supplement plan for another one. You can also drop your Medigap plan and elect Medicare Advantage.
Medigap may offer additional coverage for health care services or supplies that you get outside the U.S. Standard Medigap Plans C, D, F, G, M and N provide freign travel emergency health care coverage when you travel outside the U.S. Your Medicare Supplement plan pays 80% of medically necessary emergency care outside the U.S if you’ve met a $250 deductible for the year, but only if Original Medicare does not cover the expense. The car must begin during the first 60 days of the trip. There is a lifetime limit of $50,000 for foreign travel emergency coverage. Many Medicare shoppers ask, “What Is Medicare Plan F?” Medicare Plan F is the most comprehensive Medicare Supplement Plan. It covers both Medicare deductibles and covers copays and coinsurance too. Medigap is sold to supplement Original Medicare Parts A and B, not as a replacement for them. If you’d like the private version of Medicare, compare prices and benefits for Medicare Advantage (MA) plans here.
Medicare Part C is Medicare Advantage coverage, which is designed to offer the same coverage as standard Medicare, but through a network of private insurers. You may pay a lower monthly premium than you would for regular Medicare. You may also be offered additional benefits that Medicare A & B don’t offer. So, in essence, you’d replace Part A and Part B when you buy Medicare Part C. Unlike Original Medicare, there is an out-of-pocket limit for Medicare Advantage. In 2017, the maximum was $6,700.
Medicare does not pay for assisted living, including the cost of room, board and personal care. Medicare Advantage (MA) may cover the cost of personal care assistance as well as other supportive services in assisted living facilities. Costs for assisted living facilities range from $2000 to $6000 a month. Medicare won’t pay for this, but Medicare Advantage may pay for some of the costs. Medicaid may also cover some of these costs.
Original Medicare doesn’t cover hearing aids or exams for fitting hearing aids. You pay 100% for hearing aids and exams. However, Medicare Advantage Plans (Part C) offer coverage for vision, hearing and dental so you may be covered for hearing aids, depending on the plan.
Original Medicare doesn’t cover dental care, dental procedures, cleanings, fillings, tooth extractions, dentures, dental plates or other dental devices and supplies. Medicare Part A will cover some dental services when you are in a hospital. You pay 100% for non-covered services, including most dental care. Some Medigap plans have dental benefits, but you must shop Medigap plans carefully and make sure the plan you choose offers dental coverage. Or, you can opt for Medicare Advantage with a dental plan instead of Original Medicare.
Some Medicare Advantage plans offer dental, hearing and vision. Some plans include routing dental, routing vision and Medicare prescription drug coverage. You will have a copayment with Medicare Advantage. It’s important to shop for the Medicare plan that fits your needs.
Medicare doesn’t cover eye exams or eye refractions for eyeglasses and contact lenses. You pay 100% for eye exams and eyeglasses or contact lenses. Some Medicare Advantage plans (Part C) offer vision, hearing and dental services that Original Medicare does not cover. While Medigap will cover cataract surgery costs or other serious vision issues, eye exams, glasses and contacts are not covered by Medigap.
Medicare only covers chiropractic care for spinal subluxation. You’ll need an official diagnosis and qualified chiropractor for Medicare to cover the treatment. However, Medicare Advantage offers coverage for chiropractic care in a variety of cases.
This is your prescription drug plan, which ranged in 2017 from $16 a month to more than $71 a month. Your premium depends on your income and the plan you choose. The Part D deductible was capped at $400 for 2017.
You can enroll in Medicare even if you’re not planning to retire. It’s advised that you compare medicare rates you’d be paying with Original Medicare with the option of buying Medicare Advantage. It’s important to compare costs and benefits (like dental, vision) side by side. You may also compare Medicare with a Medicare Supplement plan with Medicare Advantage to see which is most cost effective. To apply for Original Medicare alone without a supplemental plan that offers dental, vision and hearing, visit Social Security Administration and fill out an online application.
U.S. citizens or permanent legal residents who’ve lived in the U.S. at least 5 years are eligible for Medicare at the start of the age of 65. You can sign up at the start of your initial enrollment period, which begins three months before your 65th birthday and ends three months after your 65th birthday. You and/or your spouse must have worked enough years to be eligible for Social Security or Railroad Retirement benefits. You are also eligible if you and/or your spouse is a government employee or retiree who hasn’t paid into Social Security but paid Medicare taxes.
Aside from seniors, individuals under the age of 65, who are eligible for Medicare include those with permanent disabilities and received disability benefits for at least two years. Also those with end-stage renal disease (ESRD) and those with ALS (Lou Gehrig’s disease) are also eligible for Medicare.
To shop around and see which insurer offers the most comprehensive plans that include vision, dental and hearing, you can compare Medicare Advantage plans . You can also compare Medigap plans if you want to keep Original Medicare Parts A and B. To apply for Original Medicare visit Social Security Administration and fill out an online application.
If you consider that an $86,000 surgery (heart bypass surgery average) has a copay of $17,000, you should really consider investing in a small premium for a very important coverage. We can help.
A 65-year-old retiring in 2019 will spend about $135,000 to $150,000 in out-of-pocket medical costs during their retirement. This astronomical figure has gone up about $2500 since last year. Of course, these costs would be higher if you have an existing condition or if you live longer than the average American.
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