|
The rising cost of health care has become a critical concern in our country. The ability to provide quality service at cost effective prices is a dilemma that has faced many in the government and health care industry alike. For many senior citizens, this concern is an immediate one. National statistics cite that the senior citizen segment is the fastest growing population segment in our country. For them, viable health care options are needed now.
One alternative that has been available is the Medicare program. Medicare, which has been offered for almost 20 years, is a health program administered under the Social Security Administration of the federal government. The Medicare program is composed of two parts, hospital insurance and medical insurance.
All individuals 65 years of age or older who receive either Social Security or Railroad Retirement benefits are automatically eligible for the Medicare hospital insurance. Additional medical insurance is available to eligible Medicare recipients for a monthly premium of $50 per person. These premiums are normally deducted automatically from a Social Security check.
The accompanying charts offer an overview of the Medicare benefits available and the prevailing costs. However, actual benefits and amounts paid will vary based on prevailing costs and the requirements of the covered individual. While Medicare does provide basic protection against the high cost of health care, it does not cover all medical expenses. If you are eligible for Medicare benefits, you should strongly consider supplementing the basic Medical Hospital coverage with a Medicare Supplemental Insurance Policy.
Supplemental Insurance Policies help bridge the gap between what hospitals and doctors actually charge and what Medicare pays. When choosing a supplemental policy be certain the coverage provided is over and above your existing Medicare coverage. Does the supplemental policy cover all care days not covered by Medicare? Is there coverage for expenses over Medicare? Does the supplemental policy cover all care days not covered by Medicare? Is there coverage for expenses over Medicare coverage for private or semiprivate rooms, private duty nursing care or nursing care in an approved facility? Answering yes to these questions will help guarantee that your supplemental policy helps fill the gaps.
The best time to plan for health care is certainly before care is needed. All alternatives should be reviewed against your actual needs before a final decision is made. Moreover, it is important to know all the facts first.
For more information about Medicare and supplemental insurance, contact your local Social Security office for two brochures: “Your Medicare Handbook” and “A Guide to Health Insurance For People With Medicare”.
Hospital Insurance Portion - Part A
HOSPITALIZATION SEMI-PRIVATE ROOM COVERAGE
Benefit Period: |
|
First 60 days |
Patient Pays: |
|
The first $792 |
Medicare Pays: |
|
100% of the excess over $776 |
|
|
|
Benefit Period: |
|
Day 61-90 |
Patient Pays: |
|
$198 per day for 30 days ($5,820) |
Medicare Pays: |
|
100% of the excess over $194 per day |
|
|
|
Benefit Period: |
|
Day 91-150 (lifetime reserve) |
Patient Pays: |
|
$396 per day ($23,280) |
Medicare Pays: |
|
100% of the excess over $388 per day |
POST-HOSPITAL SKILLED NURSING FACILITY CARE
Benefit Period: |
|
First 20 days |
Medicare Pays: |
|
100% of the amount |
|
|
|
Benefit Period: |
|
Day 21-100 |
Patient Pays: |
|
$99 per day ($7,760) |
Medicare Pays: |
|
100% of the excess, if any |
POST-HOSPITAL HOME HEALTH CARE
Benefit: |
|
Unlimited, only as medically necessary |
Medicare Pays: |
|
100% of specific* approved amounts |
SPECIFICS' COVERED BY MEDICARE
Semiprivate room |
Home health visits |
Speech therapy |
X-rays |
Meals served |
Medical supplies and appliances |
Regular nursing services |
Cost of special care units |
Medication |
Rehabilitation services |
Laboratory tests |
Operating and recovery room |
Medical social services |
Anesthesia services |
Physical therapy |
Psychiatric hospital care |
Medical Insurance Portion - Part B
Benefit Class
Physician's services, in-patient and outpatient medical services and supplies at a hospital; physical and speech therapy; ambulance, etc.
Patient Pays
$100 deductible, plus all excess. Some charges may be more than approved amounts and the patient should try to get the treating individual to limit collection to the Medicare limits.
Medicare Pays
Eighty percent of the approved amount (after the deductible which is currently $100).
Specific Items which May Be Covered*
- Ambulance transportation
- Artificial limbs and eyes
- Oral surgery
- Speech pathology services
- Diagnostic test and procedures
- Podiatrist services
- Durable medical equipment
|
- Medical supplies
- Out-patient physical therapy
- X-rays
|
* These specifics are only examples of services that may be covered. For more information about Medicare coverage and its limitations and exemptions, contact your Social Security office.
Premium Contribution
Effective 2000, the individual’s contribution toward Medicare insurance is $45.50 per month. This is normally deducted from the Social Security monthly check. For a couple, the cost is $91.00 per mo. These premium amounts increase every year.
Working employees and their employers are now paying a much larger portion of the Medicare cost. The percentage is 1.45 % of pay for the employee, and now there is no ceiling on the amount of earnings. Since the employer must match this by an equal amount, the total can be more than $4,000. A self-employed person must pay the entire portion. However, these persons are generally not eligible to collect benefits, since most are still under 65!
Additional Information
The Social Security Administration provides a toll free support and explanation service. While you may have to wait on the line for a service person, they are generally very helpful and will get the information you request. PHONE: 800 772-1213 |
