Medicare offers a federally subsidized drug program for seniors, in which private health insurers offer limited insurance coverage of prescription drugs to elderly and disabled Medicare recipients. The drug benefit is available only through insurers that contract with Medicare to market drug plans. What does the drug benefit cost and what do you get? Medicare recipients who elect to be covered by the drug benefit will pay premiums averaging around $33 a month in 2022. This is an average; some plans will charge more, some less. After meeting a deductible, which can’t be more than $480 (in 2022), you need to pay…
As Medicare premiums rise, a Medicare Advantage plan can seem like an attractive option. But if you are considering switching from traditional Medicare to a Medicare Advantage plan, you need to know what to look for. Medicare Advantage plans are run by private insurers, unlike traditional Medicare, which the federal government operates, although the medical providers are private. The government pays Medicare Advantage plans a fixed monthly fee to provide services to each Medicare beneficiary under their care. The less money they spend on patient care, the more money they and their investors make. The plans often look attractive because…
If you have Medicare Parts A and B, you can join a Medicare Advantage plan. Under Medicare Advantage beneficiaries may choose from a number of private health plans, which include the following: Health maintenance organization (HMO) plans that require you to go to doctors, other health care providers, or hospitals on the plan’s list, except in an emergency. You may also need to get a referral from your primary care doctor to see a specialist. Preferred provider organizations (PPOs) that allow the use of doctors and hospitals outside the plan network for an extra out-of-pocket cost. Private fee-for-service plans (PFFSs),…
Many people believe that Medicare covers nursing home stays. In fact Medicare’s coverage of nursing home care is quite limited. Medicare covers up to 100 days of “skilled nursing care” per illness, but there are a number of requirements that must be met before the nursing home stay will be covered. The result of these requirements is that Medicare recipients are often discharged from a nursing home before they are ready. In order for a nursing home stay to be covered by Medicare, you have to meet the following requirements: You must enter the nursing home no more than 30…
Medicare Part B basically covers “outpatient” care: office visits to medical specialists, ambulance transportation, diagnostic tests performed in a doctor’s office or in a hospital on an outpatient basis, physician visits while the patient is in the hospital, and various outpatient therapies that are prescribed by a physician. Part B also covers a number of preventive services. In addition, Part B covers home health services if the beneficiary is not enrolled in Medicare Part A. Medicare recipients who are eligible for Part A are automatically enrolled in Part B unless they opt out. Part B enrollees pay a monthly premium…
Medicare Part A covers institutional care in hospitals and skilled nursing facilities, as well as certain care given by home health agencies and care provided in hospices. Any person who has reached age 65 and who is entitled to Social Security benefits is eligible for Medicare Part A without charge. That is, there are no premiums for this part of the Medicare program. Medicare pays for 90 days of hospital care per “spell of illness,” plus an additional lifetime reserve of 60 days. A single “spell of illness” begins when the patient is admitted to a hospital or other covered…
If you are paying for your own insurance, you may think you do not need to sign up for Medicare when you turn 65. However, not signing up for Medicare Part B right away can cost you down the road. You can first sign up for Medicare during your Initial Enrollment Period, which is the seven-month period that includes the three months before the month you become eligible (usually age 65), the month you are eligible and three months after the month you become eligible. If you do not sign up for Part B right away, you will be subject…
The first of the 78 million baby boomers turned 65 on January 1, 2011, and some 10,000 boomers a day will reportedly reach that milestone between now and 2030. If you are about to turn 65, then it is time to think about Medicare. You become eligible for Medicare at age 65, and delaying your enrollment can result in penalties, so it is important to act right away. There are a number of different options to consider when signing up for Medicare. Medicare consists of four major programs: Part A covers hospital stays, Part B covers physician fees, Part C…
There are two main parts to Medicare, each with its own eligibility requirements. Medicare Part A which offers hospital and other institutional coverage, is available for anyone who is over age 65 or who is permanently disabled and who is eligible for Social Security or Railroad Retirement disability benefits. You are eligible for Medicare Part A if you: are a United States resident who has reached age 65 and are either a U.S. citizen or a legally admitted alien who has resided in the U.S. continuously for at least five years; are a disabled person of any age who has been entitled…
Medicare is the federal government’s principal health care insurance program for people 65 years of age and over. In addition, the program covers people of any age who are permanently disabled or who have end-stage renal disease (people with kidney ailments that require dialysis or a kidney transplant). The Medicare program insures around 62 million Americans and spends close to $800 billion a year on their care. Medicare is an entitlement program, meaning it is not based on financial need. Although Medicare was originally conceived as a program that would relieve older persons of the burden of paying for health care, Medicare beneficiaries…
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