A partnership between local law enforcement, seniors and senior service providers
Louise Mohardt, from Geriatric Services, tried to boil down to basics the complicated Medicare landscape: eligibility; what is covered by Medicare Part A and Part B; when to enroll; how to use Medicare Supplement (“Medigap”) plans to insure against expenses that regular Medicare doesn’t cover; Medicare Part D to cover prescription drug expenses; and resources available to help you figure it all out.
She emphasized the importance of reviewing Part D coverage every year, as your medications may change and your insurance company may change premiums as well as what medications are covered and to what amounts. The Medicare website (www.medicare.gov) has a tool to help you enter your current medications and compare costs of various plans, or you can call 1-800-Mecicare. Help is also available from the Virginia Insurance Counseling Assistance Program (VICAP); our local representative is Lisa Walker (804-758-2386).
You’re eligible for Medicare at age 65 and have contributed into Social Security; you can enroll through your spouse; or if you’re younger and disabled, you can also qualify. You enroll in Medicare Part A, which costs you nothing, at your 65th birthday, even if you’re not taking Social Security. If you have other medical coverage through your or your spouse’s employer, you don’t need to enroll in part B—which has a premium, currently $104.90/month—until you leave that employment.
If you have no other insurance, and fail to enroll in Part B (or Part D for prescription drug insurance), you will face a substantial penalty, Louise said.
Medicare Part A covers hospital and skilled care in a nursing home or rehab center, or for skilled home care. You will pay a deductible of $1,250 for each hospital stay, up to 60 days. After 60 days, you’ll be charged $315/day for days 61-90. After your stay, you are covered for the costs of skilled care for 20 days with no co-pay, provided you have had a 3-day hospital day (but NOT just on observation status) and are making progress.
Medicare Part B, for which you pay a premium, usually taken from your Social Security, pays for outpatient visits to doctors or therapists. There’s an annual deductible of $147 and you are charged a 20% co-pay.
Part C, Medigap
Medicare Part C is called Medicare Advantage, which combines coverage of Medicare Parts A and B, and may also include other services such as medications and dental or vision care. These are private insurance plans, usually either a PPO or HMO, that require you to use a network of physicians and hospitals and usually require referrals to see specialists.
Medicare Supplemental plans—called Medigap—offer insure you for costs not covered by regular Medicare, such as co-pays, deductibles and excess costs. There is a menu of plans offering different levels of coverage. Every insurer’s Plan A or Plan F, for example, offer the same benefits, but different companies charge different premiums.
As you can see, navigating Medicare can get pretty complicated, so take advantage of guidance and resources available from people like Louise, VICAP, etc.