Medicare Need to Knows

 

I recently attended a face-to-face class and a webinar about Medicare. Below are ten key take-aways:

Medicare Description- Medicare is a federal government health insurance program primarily for Americans (U.S. citizens and legal permanent residents) age 65+ and certain younger individuals with a qualifying disability (end-stage renal disease and ALS).

 

Medicare Administration- Medicare is administered by the Centers for Medicare & Medicaid Services (CMS), which is an agency within the U.S. Department of Health and Human Services.

 

Medicare vs. Medicaid- Medicare is a national program that is primarily age-based. Medicaid is a federal/state partnership that varies by state and is need-based (i.e., income and asset limits).

 

Medicare Parts A and B- Both parts are collectively known as “Original Medicare.” Part A covers inpatient hospital care and Part B pays for doctors’ services and outpatient care.

 

Medicare Part C- Commonly known as Medicare Advantage, Part C an all-in-one private insurance alternative to government-run Original Medicare. Coverage is coordinated by a private insurance company approved by the federal government rather than by the government itself. Some Part C plans include dental coverage. Open enrollment period every year is a time to shop around.

 

Medicare Coverage Split- According to KFF, 55% of Medicare beneficiaries are enrolled in Part C and the remaining 45% retain Original Medicare. Most people in the latter group buy Medicare supplement insurance (Medigap) to cover Medicare deductibles and coinsurance.

 

Medicare Part D- This is insurance program that helps cover the cost of outpatient prescription drugs. It can be added to Original Medicare or Medigap insurance or it can be part of a Medicare Advantage plan that bundles prescription drug coverage with medical benefits.

 

Medicare and Long-Term Care- Medicare does not cover long-term "custodial" care (help with everyday activities like bathing or eating). However, it does cover up to 100 days of skilled nursing facility care or rehabilitation following a qualifying hospital stay of at least three days.

 

Medicare Losses- Medicare experiences billions of dollars in annual losses due to fraud and abuse. Senior Medicare Patrol (SMP), a federal program, helps Medicare beneficiaries and caregivers prevent, detect, and report Medicare fraud, errors, and abuse. SMP operates in every U.S. state.

 

Medicare Appeals- Beneficiaries can appeal a decision not to cover a specific medical procedure. A common culprit is that the billing code was entered incorrectly. About 70% of appeals are successful. Of course, documentation is needed to present a strong case.

This post provides general personal finance or consumer decision-making information and does not address all the variables that apply to an individual’s unique situation. It does not endorse specific products or services and should not be construed as legal or financial advice. If professional assistance is required, the services of a competent professional should be sought.