By Rick Banas of assisted living provider BMA Management, Ltd.
Mahja Sulemanjel and Jorie Gustafson of HCR ManorCare conducted a free informational program on Medicare last week at the Heritage Woods affordable assisted living community that BMA manages in South Elgin, Illinois.
Here is some important information to keep in mind:
Medicare was created in 1965. The primary purpose of the program is to provide health coverage for individuals 65 years of age and older.
There are four parts to Medicare, with Part C being added in 1997 and Part D in 2003.
Medicare Part A (Hospital Insurance)
There is no charge for Medicare Part A if you are eligible.
A person, or the spouse of a person, who has worked in Medicare-covered employment for at least 10 years (40 quarters), and is a citizen or permanent resident of the United States and at least 65 years of age is eligible. Among those who also are eligible are those who meet Social Security or Railroad Retirement disability requirements and those with end-stage renal disease.
Since Medicare helps cover inpatient care, be careful not to assume that just because you are in a hospital overnight or just because you are taken to a hospital room does not necessarily mean that you are an inpatient. Make sure that you are clear about whether the hospital has admitted you as an inpatient versus holding you for observation.
Also, be careful not to assume that Medicare benefits apply just because you have been admitted into a nursing home. Medicare does not cover custodial care or long-term care in a nursing home. Medicare coverage only may apply if you require daily skilled nursing or daily rehabilitation services and have been an inpatient in an acute care hospital for at least three consecutive midnights within 30 days of being admitted to a skilled nursing facility. Being in the hospital for observation does not count. You also must be admitted to a Medicare-certified bed. Up to 100 days may be covered, with co-payments applying after the first 20 days.
Medicare Part B (Medical Insurance)
You pay a premium each month for Medicare Part B.
Medicare Part C – Medicare Advantage
Different types of Medicare Advantage plans are available such as Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and fee-for-service plans.
You usually pay a monthly premium in addition to your Medicare Part B premium for a Medicare Advantage plan.
Each Medicare Advantage Plan can charge different out-of-pocket costs.
Medicare Part D – Prescription Drug Coverage
Through Medicare Part D, Medicare offers prescription drug coverage to everyone on Medicare to help them with the cost of prescription medications.
To get the coverage, you must join a plan run by an insurance company or a private company approved by Medicare.
A variety of plans are available, with each plan varying in terms of drugs covered, monthly costs and potential out-of-pocket expenses.
Keep in mind that if you do not enroll in a Medicare Part D Plan when you first become eligible and you do not have other creditable drug coverage, you likely will have to pay a late enrollment fee penalty.
For More Information
You can access a CMS Medicare & You Handbook by clicking here.
Additional information also is available at medicare.gov
“BMA Management is the leading provider of affordable assisted living in Illinois
and one of the 20 largest providers of assisted living in the United States.”
