THIS IS ABOUT Medicare (again).
It is not about Part D.
In fact, it’s not about anything that you need to care about until Jan. 1, 2019, but by then you might care about it so let’s proceed judiciously.
In most years, there is a Social Security “COLA” (cost-of-living adjustment), and not far behind is usually the news regarding increased Medicare costs, one of the most notable (sometimes) being an increase in the premium for Part B.
What operates behind the scenes — meaning that you don’t usually hear about them until life circumstances force you to confront them — are the rates/payments/percentages for various covered services, meaning covered by Medicare.
So, we’re going to cruise some of those today, remembering that these are effective Jan. 1.
First, are we all clear that for Medicare Part A, we can think hospital, (more or less) and for Medicare Part B, we can think doctor, (more or less).
Let’s start with Part A, hospital insurance.
For the first 60 days of basic hospitalization, Medicare pays all but $1,364, so that’s the amount that would fall to us.
For the 61st to the 90th day, Medicare pays all but $341 per day, so that would fall to us and for the 91st to 150th day, Medicare pays all but $682 per day.
The good news here is that it’s very rare for anyone to experience hospital stays of these lengths (not impossible, but rare).
Note: These services are based on benefit periods.
A benefit period starts on the first day you receive a Medicare-covered service in the hospital, and ends when you’ve been out of the hospital (or other facility that provides skilled nursing or rehab services) for 60 days in a row.
For skilled nursing facility care (think rehab in a nursing home), Medicare pays 100 percent of the approved amount for the first 20 days.
This is the famous “you need to be admitted to the hospital for three nights” thing.
For the next 80 days, Medicare Part A would pay all but $170.50 per day, so the $170.50 would fall to us.
Home health care, the best secret weapon for anyone who needs skilled nursing care/therapies at home, is covered at 100 percent for as long as you meet the Medicare requirements, which are actually fairly liberal.
This benefit also will pay 80 percent of the approved amount for durable medical equipment.
Part A covers hospice care (from a Medicare-certified hospice agency) for as long as a doctor certifies need, with limited cost sharing for outpatient drugs and inpatient respite care.
Let’s move to Part B.
It covers doctor services, outpatient medical and surgical, physical/speech therapy, etc., plus most outpatient mental health service, plus a great deal more.
The benefit is unlimited, meaning that there is no time or dollar cap imposed.
Part B will pay 80 percent of the approved amount, after a $185 deductible (in 2019) so we pay the $185 plus the 20 percent that Medicare didn’t pay.
Clinical laboratory services generally are paid at 100 percent of the approved amount.
Outpatient hospital treatment is paid at 80 percent of the approved amount, so we pay the remaining 20 percent.
I could go on ad infinitum with details, but I won’t.
Generally, Medicare Part B provides relatively decent coverage.
What a lot of us seem to miss is that 80 percent/20 percent thing, so look back at those for Part B then cruise back up to the Part A stuff and notice the deductibles, etc. that we have to pay.
Right.
The naïve among us tend to assume that Medicare pays for all of everything.
It doesn’t. It never has, so that’s why some folks decide to purchase Medicare supplemental policies (MediGaps, MedSupps,) to pay all or some of those costs that fall to us.
MediGaps are standardized plans (Plan A, Plan F, etc.) that are sold by private insurance companies.
They are not mandatory.
For those of us who reside in traditional Medicare (as opposed to Medicare Advantage Plans), they can be a huge blessing, but we have to be able to afford them. The plans and premiums vary widely and are well beyond anything we can take on here today.
Obviously, this is very general information.
If you have questions or concerns about your specific situation, call any of the numbers at the end of this column and decent people will help you for free.
What’s the best way to avoid undue Medicare costs?
Stay healthy. (No, I’m not kidding).
And, we haven’t even touched Medicare’s preventive benefits. But we will.
After all, there’s a limit to how much of this stuff anyone can absorb in one sitting.
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Mark Harvey is director of Clallam/Jefferson Senior Information & Assistance, which operates through the Olympic Area Agency on Aging. He is also a member of the Community Advocates for Rural Elders partnership. He can be reached at 360-452-3221 (Port Angeles-Sequim), 360-385-2552 (Jefferson County) or 360-374-9496 (West End), or by emailing harvemb@dshs.wa.gov.
