Fact: Most people over 65 will receive the benefits of Medicare Part A ‘premium free’. An exception would be if you have not paid Medicare taxes for at least 39 quarters.
Most of our clients enrolling for Medicare, while not necessarily welcoming the event, e.g. reaching 65, are glad to know that their potential Hospital costs (part A) and Medical costs (part B) will be funded by the state.
If you are approaching age 65 (you or your spouse) you should contact your preferred Health Insurance Exchange.
Most people over 65 will receive the benefits of Medicare Part A ‘premium free’. An exception would be if you have not paid Medicare taxes for at least 39 quarters.
Medicare Part A. What does it cover?
If you are hospitalized for any reason (this includes mental health inpatient stay) there will be a deductible, currently $1364 for each benefit period (normally 12 months).
When the deductible amount has been reached you are entitled to up to 60 days inpatient care covered by your Medicare insurance, effectively free of charge.
Thereafter, there is a sliding scale of coinsurance.
Part A is concerned with CARE, whether in a
- Qualifying nursing establishment
- as a mental inpatient.
PART ‘A’ does NOT cover medical expenses
Part B is concerned with the cost of Medical Care i.e. the: –
- Medically necessary services and supplies needed to diagnose and treat your condition
- Preventative services i.e. the health care that can prevent illness or detect it at an early stage when treatment may be most effective.
For a complete list of the services covered check with TrueCoverage.com or medicare.gov
For individuals with incomes of less than $85000 pa, and for families with joint incomes less than $170000 the monthly premium is $135.50. For citizens with incomes higher than this there is a graduated scale of premiums. (see medicare.gov).
- Most doctor services (including doctor services while you’re a hospital inpatient)
- Outpatient therapy
- Durable medical equipment (DME)
In the event of surgical treatment or extended therapy this can be hugely expensive.
According to Brenda Swain, Medicare Sales Manager at TrueCoverage, many people believe that when they have Original Medicare Parts A and B they are fully covered. “It is only when they go to see a medical provider, they are shocked to find they are still on the hook for 20% of the bill’.
Is there a way around this? YES!
First, there are Medicare Advantage plans (Part C) which are designed to complement the Medicare Plans A&B by providing coverage designed to suit your personal circumstances. Medicare Part D addresses coverage for Prescription drugs which for many elderly citizens is an increasing concern.
Both types of coverage are premium based but will ensure that your co-pays and co-insurances are lower.
Keep your anticipated needs under review with your physician.
You have an open opportunity to enroll or change your C and D plans on an annual basis, normally between January 1st and March 31st each year.
Your needs and expectations change with time! Your insurance coverage should keep pace.
Complicated- you bet!
Call us and tell us what you need!
Our commitment is to find you the health insurance policies that offer you and the security and affordability of your dependents.