At the ripe age of 36 my father swiftly pointed out that I am now middle aged. I let that sink in for a terrifying moment but quickly retorted that at the age of 65 he is now eligible for Medicare. His face fell. Not because he was shocked he was so old, no, I’ve been telling him that for decades – he was giving me a look of bewilderment. It was very similar to the look my 1 1/2 year old son gave me when I introduced him to the potty. He was confused and rightfully so. Medicare is confusing. So it the potty for someone who has only known diapers, but I digress.
It’s not as simple as Medicare AB – which most folks are familiar with. Now there is Medicare A, Medicare B, Medicare C, Medicare D, Medigap plans, supplemental Medicare plans, managed Medicare, Medicare Advantage…to name a few. And what Medicare plan pays for what is another puzzling nightmare to most – but I hope this blog post helps you see that it isn’t hopeless and maybe give you some useful information which in turn can help you make the most appropriate choice to fit your healthcare needs. Minimally I hope you have a chuckle or two.
We’ll start with the basics.
Most people don’t pay for this coverage but there is a yearly deductible for this coverage – $1,316 for 2017. If you or your spouse paid Medicare taxes while working you’re eligible. Medicare A will cover you if you are admitted to the hospital, need a short term nursing home stay, home health or hospice. It will pay for your hospital stay while it’s medically necessary only – which is determined by your treating physician. It will also pay for your nursing home stay in a skilled nursing facility (SNF) while you have a certified skilled need – which is also determined by your treating physician. I would explain the definition of “medical necessity” and “skilled need” but I am limited to 500 words or less and this chatty Cathy needs to rein it in!
Most will pay $134 a month for this coverage, more or less, depending on your income. If you let Medicare take it directly from your social security benefit, you will pay less. You will also have a $183 per year deductible. After your deductible is met, you will have a 20% co-pay for all Medicare B services. This includes preventative services – yearly “wellness” visit, mammograms, tests for glaucoma, cancer screenings, your flu shots and a 2 week paid vacation to the island of your choice. I joke about the vacation but I am writing a letter to my Senator to include this benefit in the future. Wish me luck!
Medicare B will also cover your hospital stay if you are admitted to the hospital observation. But an explanation of what that means for you and your checkbook as well as deciphering the maze of the Managed Plan world will be for next time. Until then, stay healthy!
Stay tuned for Part 2 when we discuss the difference between Medicare C, Medicare D, Medigap and more. In the meantime, visit Medicare.gov for more information.
Rachael Taylor-Marsh, MSN, RN, CCM, is an appeals coordinator and case management & social work lead at the University of Vermont Medical Center.