4000 Spring Garden St., Suite G • Greensboro, NC 27407 Office 336-851-5633 • Fax 336-851-5634 The ABCD’s of Medicare What is Medicare, and what does it cover? Medicare is a publicly funded health insurance program for people Age 65 and older, or who have certain qualifying disabilities. Part A provides coverage for inpatient hospital stays, skilled nursing facilities, and some home healthcare. Deductibles and/or coinsurance may apply. Part B covers Medicare-eligible physician services, outpatient hospital services, certain home health services, and durable medical equipment. Part C covers both physician services and hospital care through a private health plan known as a Medicare Advantage plan. Medicare Advantage plans give you the option of expanded benefits, such as built-in Part D prescription coverage, lower co-pays for doctor and hospital visits, and additional services such as vision and dental care.
The types of Medicare Advantage plan’s available include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO) and Private Fee-for-Service (PFFS). Part D provides coverage for prescription drugs. 2016 MEDICARE PART A When you are hospitalized for: MEDICARE COVERS You Pay 1-60 Days Most confinement costs after the required Medicare deductible $1288 61-90 Days All eligible expenses after patient pays a per-day copayment $322 A Day Copayment as much as $9,660
91-150 Days All eligible expenses after patient pays a per-day copayment. (These are lifetime Reserve Days that may never be used again) $644 A Day Copayment as much as: $38,640 151 Days or More Nothing You pay All Costs Skilled Nursing Confinement: (At least 3 days and enter a Medicare approved skilled nursing facility within 30 days after hospital discharge and receive skilled nursing care) All eligible expenses for the first 20 days, then all eligible expenses for days 21-100 after patient pays a per-day copayment After 20 days $161.00 A Day Copayment as much as: $12,880 2016 MEDICARE PART B On expenses incurred for: MEDICARE COVERS You pay $166 Annual Deductible Plus Medical Expenses Physician services for inpatient/outpatient Medical/Surgical Services; Therapies/diagnostic tests 80% Of approved Amount 20% Of approved Amount
Clinical Lab Services Blood tests, urinalysis Generally, 100% of Approved amount Nothing for Services Home Health Care Part-time or intermittent Skilled care; home health aide services; durable medical supplies; other 100% of approved amount; 80% of approved amount for durable medical equipment Nothing for services; 20% of approved amount for durable medical equipment Outpatient Hospital Treatment Hospital services for the diagnosis or treatment of an illness or injury Medicare payment to hospital, based on outpatient procedure payment rates You pay All Costs Blood 80% of approved amount after first three pints of blood First three pints; plus 20% of approved amount for additional pints
Part A Part B $104.90 ($121.80 New to Medicare in 2016) Plus, you’ll need to add Part D Average Part D cost ---- $40-$45 OUT OF YOUR POCKET Part A Part B $104.90 ($121.80 New to Medicare in 2016) Plus, you’ll need to add Supplement cost ------- $125-$150 (Varies by age and plan type) There are 10 standardized plans to choose from. You have no co-pays or co-insurance with supplement plan F With Plan G you pay Part B deductible. Then it works like Plan F Plus, you’ll need to add Part D Average Part D cost ----- $40-$45 You owe Part A Part B $104.90 ($121.80 New to Medicare in 2016) Part C (Medicare Advantage) Part C cost ------------- $0 - $78 (Many plans have NO premium and most include Part D) These plans do not supplement Medicare They have co-pays and when you use them. Part C has gaps in coverage, however offers you a MOOP (3,400-6,700) If you go with Part C, you need a Companion plan cost -- $30-$50 (Varies by age and plan type)