You may have seen deductions on your paychecks for Medicare and Social Security. These deductions support federal health insurance for those who are over age 65, have specific disabilities, or have end-stage renal disease (ESRD).
Uganda Gaines, Corporate Billing Director with Chicago Methodist Senior Services, breaks down what exactly Medicare is, what its benefits are and how to understand Medicare coverage for older adults.
What Exactly Is Medicare?
Medicare is the federal health insurance program for people 65 or older, certain younger people with disabilities and people with end stage renal disease (permanent kidney failure). There are four parts of Medicare: Part A is hospital insurance; Part B is medical insurance, Part D is prescription drug coverage, and Part C is an alternative to Original Medicare that bundles Part A, Part B and usually Part D.
For those who continue to work after age 65, Medicare benefits are still available because they’ve been earned. If you have insurance through your job, Medicare would pay as secondary.
“Your employer group health plan would be your primary insurance, and then Medicare would pay secondary for any Medicare-covered services,” explains Gaines.
You are eligible for Medicare if you or your spouse has worked and paid Medicare taxes for at least 10 years. If you already receive Social Security benefits, you don’t need to do anything. You will be automatically enrolled.
“They’ll send you a letter the year you’re going to turn 65 to let you know you’re eligible,” shares Gaines. “Your Part A benefits will become effective as of the first of the month on the month you turn 65.”
Part A covers your inpatient stays (like hospital admittance) and care in a skilled nursing facility, hospice or home health. “Medicare covers 100 days in the skilled nursing facility,” notes Gaines. “The first twenty days are covered at 100 percent and days 21 to 100 are covered—everything is covered except for a per-day co-insurance, which for 2019 is $170.50.”
People who require surgery must be in the hospital for three consecutive nights to receive that 100-day benefit. The benefit replenishes after someone has been out of the hospital for 60 days.
Understand Optional Medicare Coverage For Older Adults
People who are eligible for Part A can take advantage of Parts B and D for additional premiums. Part C bundles the coverage for inpatient hospital stays, medical needs and prescription drugs.
“More than likely, you’re going to use more of your Part B benefits than your Part A, because you’re going to visit your doctor’s office more than you would be admitted to the hospital,” Gaines points out. Premiums for Part B are automatically deducted from your Social Security check.
Part D is prescription drug coverage. This benefit is also available at a premium.
Medicare Part C, also called Medicare Advantage, is a newer plan (established in 1997). It combines the benefits of Parts A, B and D into a single plan. These private insurances that operate under Medicare provide coverage in place of Original Medicare coverage. There are many different options available. “If you’d like the ones with dental coverage or with vision coverage, there are some plans that would cover that, and all of them cover prescriptions,” says Gaines.
For more information or to better understand Medicare coverage for older adults, call 1-800-MEDICARE or visit www.medicare.gov. Listen to our podcast episode on how to understand Medicare coverage for older adults with Uganda Gaines, Corporate Billing Director with CMSS, here.