I Thought Medicare Covered That!
By CarePatrol of Chicago Northshore
The family meeting about senior living options for Dad went well, right up until the discussion about the cost. The oldest son boldly stated, “We don’t have to pay for it, Medicare will cover assisted living.” Wrong. This is not legal advice but my attempt to debunk the myths surrounding Medicare in a few easy steps:
- Original Medicare
- Secondary Coverage
- Medicare Supplement/MediGap Plan
- Part C/Medicare Advantage Plan
- Part D Prescription Drug Coverage
Original Medicare Parts A and B are controlled by the Federal government. If you earn 40 quarter-hours through social security contributions, there is no premium for Part A. Part B premiums are based on adjusted gross income for the past two years and will vary for each person.
If you are 65 or older and a legal US citizen, you qualify for Medicaid. If you have a qualifying disability for 24 months you can be under 65 and enroll in the 25th month. You can enroll 3 months before and after turning 65. Open enrollment is from October 15 to December 7. You can’t make changes to Part C or D unless you qualify for a special election. You can cancel Medicare Part C and purchase Part D between January 1 and February 14.
You get a special election option by moving out of a geographical area, qualifying for Medicare Extra Help, becoming dually eligible for Medicare/Medicaid, or working past 65 and obtaining Part B by leaving your employer’s health plan.
The reason to get secondary coverage is to cover deductibles and co-pays that original Medicare does not cover.
All federally regulated Supplement and Medigap plans A to N offer different coverages. All plans within a letter group offer the same benefits regardless of carrier. Premiums and yearly increases will vary by carrier. Part C are Medicare Advantage Plans (some with or without drug coverage) vary by where you live and have travel coverage outside the US. Get Part D drug coverage when you qualify for it. Also, check to see if you qualify for VA benefits or employer group coverage.
Now that you have an overview of the Medicare mess we can get answer the original question – what does Medicare cover? Part A covers inpatient hospital stays, skilled nursing, hospice, labs, and home health. Part B covers doctors and outpatient visits. Advantage plans cover medical and drugs and possibly additional coverages privately. Part D covers prescription drugs. Medicare does NOT cover assisted living.
Congress wants to reduce medical overuse and 2020 will bring changes to Supplement/Medigap plans. Some plans will no longer be available and others will be grandfathered in. Some choose to navigate the Medicare confusion on their own. Others hire licensed Medicare Agents to guide them on the Medicare journey. CarePatrol is here to help guide you to those resources.