• Medicare - "Alphabet Soup"

    PART A, PART B, PDP, PLAN F, PART C

    Part A

    PART A includes the room and board of the hospital and skilled nursing coverage for Medicare. As long as you have worked for ten years, or forty quarters, the contributions to Medicare have already earned this benefit, so, there is no extra charge. If you were married ten years or more, and your spouse has worked ten years or more, you are still eligible under your spouse's contribution at no extra charge. In addition, as long as it is precipitated by a three day admitted hospital stay, you are eligible for rehabilitative services, which is referred to as skilled nursing. Since that term is often confused with nursing home services, which are not covered by Medicare, we will associate rehab and skilled nursing interchangeably.

     

    Beware that hospital stays under observation status, do not qualify for the rehab benefit under original medicare. There is an advocacy group working to have the observation days under Medicare count for the skilled nursing benefit, but, they have been unsuccessful thus far.

    Hospital Stay

    When the client with Original Medicare enters the hospital, there is a deductible due. Once the deductible is paid, Medicare coverage begins and it covers a 60 day benefit period. If you reenter the hospital during that benefit period, the same deductible covers your stay. If you reenter the hospital after the 60 day benefit period expires, a new deductible will apply. The amount of the deductible is determined by Medicare and can change annually.

    Skilled Nursing/Rehab

    Also, under your Part A benefit, you are eligible for Rehab, often referred to as skilled nursing care. Not to be confused with nursing home or long term care which Medicare does not cover.

     

    As long as you are admitted to the hospital for three days, Medicare will pay your room and board for the first 20 days of rehab at no cost to you. Days 21-100 are available for a daily copay which cost does change annually, and any stay over 100 days must be paid by you, or your long term care insurance.

    Part B

    PART B covers two types of services for Medicare participants which includes both preventative as well as those which are medically necessary to diagnose or treat medical conditions. Part B covers doctor visits whether you see them in an office, the hospital or in rehab (skilled nursing.) Part B covers ambulance services, durable medical equipment (crutches, splints, walkers, hospital beds, scooters), as well as some injectable drug treatments. There is a monthly charge for Part B services as well as a penalty if you delay coverage.

    Part C

    PART C combines the services of both Part A, Part B, and sometimes Part D, into a managed health plan referred to as a Medicare Advantage Plan. While you need to be eligible for Medicare, the plans are supplied by independent insurance companies. The coverage has a designated network of doctors and facilities and some include prescription drugs as well as minimal dental and vision services. Participants must be well versed in the plan since there are costs associated not only with each service but pertaining to where the service is obtained. When enrolling in an Advantage plan, it should be viewed as a contract with changes expected annually. While enrollment can roll over each year, be forewarned and aware of changes to services and costs.

    Part D

    PART D refers to prescription drug coverage for Medicare eligible enrollees. It is a stand alone prescription drug plan for persons who are enrolled in Medicare Part A. You may be enrolled in Part B to qualify, though it is not necessary and you cannot be enrolled in Part C since they have their own drug plan.

  • Medicare 101

    Nesting Net and its affiliates are not connected with the federal Medicare program

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