Medicare is a book in itself.
For most people, Part A is premium-free because Medicare taxes were withheld from earned income during your working years. However, persons with less than 10 years of covered employment can purchase Part A insurance by paying a monthly premium that could be as much as $426.00. You are required to pay the first $1,260.00 of hospital costs per benefit period, which begins when you enter a hospital or skilled nursing facility and ends when you haven’t received any further care for 60 straight days. After you pay that deductible, Medicare will pay all other costs through day 60. For longer hospital stays, there are coinsurance charges of $315.00 a day for days 61 through 90, and $630.00 a day for up to 60 additional “lifetime reserve” days.
If you receive care in a skilled nursing facility following a hospitalization, you are entitled to up to 20 days each benefit period. For days 21 through 100, you will pay coinsurance of $152.00 a day. Hospital or skilled nursing care must be medically reasonable and necessary, which means that if the treatment could safely and effectively be given in an outpatient setting, Part A will not provide coverage. However, if you are homebound, you can received certain medically-necessary home health services without co-pay. Medicare does not pay for elective and cosmetic surgery; nor will it cover vision, hearing, or dental services unless they are medically necessary.
Persons already enrolled in Part B who have the premium deducted from their Social Security check will pay between $104.90 (up to $85,000.00 per year in income) and $335.70 per month depending upon marital status and income. After a modest deductible Medicare Part B will pay 80% of the Medicare-approved amount for doctors’ services, outpatient therapy, many lab tests, preventive services and durable medical equipment. You are responsible for the other 20%. Part B will pay for certain medications administered in a doctor’s office (for example, cancer drugs taken as outpatient treatment).
You can supplement your Original Medicare coverage by purchasing a “Medigap” insurance policy. They pay some or all of the deductible and coinsurance gaps in Medicare Parts A and B. The best time to buy a Medicare supplement policy is when you first enroll in Part B, because you can select any Medigap policy sold by any company, without regard to preexisting health conditions. There are numerous types of plans available that cover very little or most of the costs not covered by Medicare.
A Medicare Savings plan may be able to help you pay for Parts A and B of Medicare. It is a Medicaid program and is jointly funded by the federal government and each state. This Medicare Savings Program is called “Healthy Horizons” in Pennsylvania. Various levels of assistance are possible, depending on your income; but the resource (or asset) limitations are very restrictive. The resource limit is waived for beneficiaries who have dependent children living with them. You can get information from your local area agency on aging.