Medicare

What is Medicare?

Medicare is a federal health insurance program that pays benefits to those age 65 and older, disabled workers and other qualified individuals. It's a social insurance program. You're entitled to benefits because you pay into the Social Security system during your working years. The program includes hospital insurance (Part A) and supplemental medical insurance (Part B). Part A covers inpatient hospitalization, some home healthcare visits and limited post-hospital care. Part B covers physician care, outpatient care, certain home health visits and other medical services.

Who is covered under Medicare?

Medicare covers all who qualify, regardless of age, medical condition or ability to pay. At the age of 65, you qualify for Medicare Part A if you or your spouse paid into Social Security or the Railroad Retirement system for at least ten years. You automatically qualify for Part B when you turn 65. Certain younger people with disabilities may also qualify for Medicare benefits and supplemental policies.

The benefits for 2012 under Medicare parts A & B are as follows:

• $140.00 Medicare Part B Deductible
• $1,156 for a hospital stay of 1-60 days each benefit period
• $289 per day for days 61-90 of a hospital stay each benefit period
• $578 per day for days 91-150 of a hospital stay each benefit period
• $144.50 per day for days 21-100 of a skilled nursing facility stay each benefit period
• All costs for each day of a skilled nursing facility stay after day 100 in the benefit period
• 20% of the Medicare approved amount for most doctor visits, outpatient therapy, preventive services, and durable medical equipment
• $0 for Medicare approved home health services
• $0 for Medicare approved clinical laboratory services
• 50% for most outpatient mental health services
• All costs for the first 3 pints of blood you get as part of an inpatient hospital stay (unless you or someone else donates blood to replace what you use)
• All costs for the first 3 pints of blood you get as an outpatient, then 20% of the Medicare-approved amount for additional pints of blood (unless you or someone else donates blood to replace what you use)

Note: If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $99.90 per month in 2012. For additional details, click on the following link: Medicare Part B Monthly Premiums in 2012.

What is a benefit period under Medicare? A benefit period begins on the first day you are admitted to the hospital or skilled nursing facility, and ends on the 60th consecutive day that you are out of the hospital or skilled nursing facility.

Medicare was designed to pay a portion of your doctor and hospital bills, but it's not designed to cover all of them.

That's where Medicare supplement insurance or Medicare Advantage plans become important. This type of insurance coverage helps give you the financial resources to cover expenses Medicare won't. Because you can potentially have several "benefit periods" in one years' time, you can understand why so many individuals are purchasing either a Medicare Advantage Program, or a Medicare Supplement.

We can also help you to find a prescription drug plan to fit your needs. There are so many out there to choose from, but we will work with you to find the one that matches your prescription needs.

Useful Links

For more information go to: www.medicare.gov or www.cms.gov