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Medicare has been a Godsend for many Americans. There are now roughly 52.3 million Americans on Medicare; 43.5 million due to age and another 8.8 million because of disability. Medicare beneficiaries averaged $11,901 in total benefits this past year of which $5045 was Part A, $5092 Part B and $1773 Part D (more about Parts A, B and D later).
If you don’t think Medicare can be incredibly helpful, consider this. Both my parents died after long hospital stays and it cost them (or us) practically nothing. I have a friend who had emergency surgery last year. The total bill for his surgery and hospital stay was north of $120,000. What did it cost him? A little over $1200.
If you haven’t noticed, the cost of medical care has skyrocketed over the past 10 years. Consumer Reports recently reported, “Person for person, health care in the U.S. costs about twice as much as it does in the rest of the developed world. In fact, if our $3 trillion health care sector were its own country, it would be the world’s fifth-largest economy. “
If you haven’t yet reached the age where you’re eligible for Medicare we don’t have to tell you how expensive health insurance can be. But even if you’re a number of years away from 65 there are some things you need to know about Medicare before you need it.
There are four parts
There are four parts to Medicare. Part A includes hospital insurance. Part B includes medical insurance. Part C is known as Medicare Advantage. It includes all the benefits and services of Parts A and B along with some additional benefits and is operated by Medicare-approved private insurance companies. Part D, which was introduced under President George W. Bush, added prescription drug coverage.
The eligibility requirements
To be eligible for the original Medicare (Parts A and B) you must be either a U.S. citizen or legal resident and age 65. You would also qualify if you have been entitled to Social Security disability for at least two years, have end-state renal disease, require transplant or dialysis and are currently insured.
When to enroll
If you receive Social Security, U.S. Civil Service or Railroad Retirement benefits you will be automatically enrolled in Medicare Part A. If not there is an important seven-month enrollment period that overlaps your 65th birthday. The way it works is that if you want immediate coverage you must apply three months before you turn 65. If you wait and apply during the four months following your 65th birthday, you won’t have coverage for one to three months after you enroll.
If you fail to enroll during the seven-month period you will be penalized unless you or your spouse has health insurance where you work. The way this penalty works is for every year you fail to sign up, your Part B premium will go up 10% … and that’s forever.
There is a special enrollment period if you or your spouse is over 65 and covered by health insurance at your workplace. If this is the case you could delay signing up. If you do enroll then Medicare becomes the second payer. And if you enroll in Part B you will receive practically no benefits. You may also lose your Medicap enrollment guarantee.
What it costs
Generally speaking there is no cost for Medicare Part A. If there is some reason why you don’t qualify you can buy Part A coverage for a premium.
If you are eligible for Part A you’re also eligible for Part B. However, it ‘s optional. Premiums for Part B coverage start at $104.90 and are based on your adjusted gross income. If you sign up for Part B it will be automatically deducted from your Social Security monthly payments. Part B covers physician and outpatient care, home health, medical supplies and preventive services. It requires a co-pay of 20% of the covered benefit. Medicare doesn’t pay for everything.
As great as Medicare can be, Parts A and B won’t pay all your medical expenses because of their deductibles and co-pays. In the case of Part A (hospital) coverage, there is a cost or deductible of $1216 for the first 60 days. It then jumps to an additional $321.50 a day for days 61 through 90 and then $630 a day for hospital stays beyond that.
These deductibles and co-pays are reasons for the afore mentioned Medigap or Medicare Supplement Insurance, which is designed to fill the “gap” between what Medicare covers and its deductibles and co-pays. There are 10 standardized Medigap policies to choose from. As you might guess, the more these plans cover the more they cost. As an example of this, Medicare Supplement Insurance Plan “A” includes 100% of Parts A and B but not the Part B deductibles. Plan C covers 100% of Parts A and B and includes 100% of Part B deductibles. Plan G is sort of the Cadillac of these plans as it provides 100% coverage of all deductibles, co-pays, excess charges; hospice care and skilled nursing facility care coinsurance.
The paperwork
The one downside of Medicare coverage is the bills and it’s important to review them carefully. We know that when you see your charges there will be a lot of medical mumbo-jumbo thrown at you so you may have to get out your dictionary or call your healthcare provider for some explanations. As an example of this the term “transdermal Clonidine procedure” means you had a Clonidine patch for some period of time. If you don’t remember having a patch or if you don’t have hypertension (which is what Clonidine is meant to treat) you need to call and dispute this.
Be sure to pay you bills
As painful as it might be you need to pay your medical bills as quickly as you can. If you don’t, your healthcare provider(s) could turn them over to a bill collector and this is something you definitely don’t want to happen. If you can’t pay your bills you should contact your healthcare provider and ask about arranging a payment plan. Depending on your circumstances you might also be able to negotiate a reduction in you bills. Barring that you could put the charges on a credit card or cards or get a debt consolidation loan. While these alternatives might not seem very appealing they are definitely better than letting your medical bills go to a collection agency as this would not only have a bad effect on your life but would also severely damage your credit score.
