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The MEDICARE Myth
Finally, you're nearing 65 and closing in on retirement.
Now the government will pay your health care bills, right? In
the inimical words of CAPT Kirk, "Stand by for ram!" You will continue
to shell out your cash. Let's start with MEDICARE Part A.
It's the part of the MEDICARE which covers hospitalization.
While it's true you don't pay any premiums for it, let's face it; you've
been paying into it for years. But are you escaping all cost for your
hospital stay? Actually, you pay a deductible of $1,132.00 for a
semi-private room up to 60 days. From day 61 to the 90th you will pay
$275.00 a day in the hospital or rehabilitation facility. Thereafter, you pay
$550.00/day (while using your 60 lifetime reserve days) and from then on you
pay 100% of the bill. Now consider the costs associated MEDICARE Part
B.
Part B covers the medical services, both in and out of the
hospital. Such services as doctors, nurses, etc. First of all
you pay a premium for this coverage. If you are receiving Social
Security payments, It happens automatically when you sign up for MEDICARE.
The premiums listed below are deducted from your Social Security check.
(SEE THE TABLE BELOW FOR AMOUNTS DEDUCTED, PER PERSON.)
Medicare Part B Premiums
2011
|
Annual Income
Medicare Adjusted Gross Income/Earned Income |
Total Monthly Premium Amount
2010
2011 |
|
$85,000 or less (individual)
$170,000 or less (married) |
$110.50/month |
$115.00/month |
|
$85,001 to $107,000 (individual)
$170,001 to $214,000 (married) |
$154.70 |
$161.50 |
|
$107,001 to $160,000 (individual)
$214,001 to $320,000 (married) |
$221.00 |
$230.70 |
|
$160,001 to $214,000 (individual)
$320,001 to $428,000 (married) |
$287.30 |
$299.90 |
|
>$214,000 (individual)
>$428,000 (married) |
$353.60 |
$359.10 |
In addition to the premium, you are faced with coinsurance
and deductible costs when you use medical services. These are
Medicare Was Never Designed to Cover Everything
Options:
|
Medicare Supplements
(Medigap)
 |
Indemnity Design |
|
Plans are standardized |
|
Pays after Medicare pays its portion |
|
Portable |
|
More provider choices |
|
Available Nationally |
|
Group options available |
|
Medicare Advantage
|
Contracted with Medicare |
|
Available on Per County Basis |
|
Medicare Pays the Health Plan A Capitated Fee |
|
Mostly PPO Models |
|
Specific Providers for
In-Network Benefits |
|
Benefits and Premium can vary
by county |
|
Benefit Chart of Medicare Supplement Plans
Sold for Effective Date on or After June 1, 2010
|
A |
B |
C |
D |
F/HDF* |
G |
|
Basic, Including 100% Part B Coinsurance |
Basic, Including 100% Part B Coinsurance |
Basic, Including 100% Part B Coinsurance |
Basic, Including 100% Part B Coinsurance |
Basic, Including 100% Part B Coinsurance |
Basic, Including 100% Part B Coinsurance |
|
|
Skilled Nursing Facility Coinsurance |
Skilled Nursing Facility Coinsurance |
Skilled Nursing Facility Coinsurance |
Skilled Nursing Facility Coinsurance |
Skilled Nursing Facility Coinsurance |
|
|
Part A Deductible |
Part A Deductible |
Part A Deductible |
Part A Deductible |
Part A Deductible |
|
|
Part B Deductible |
|
Part B Deductible |
|
|
|
|
|
|
|
Part B Excess (100%) |
Part B Excess (100%) |
|
|
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Foreign Travel Insurance |
Foreign Travel Insurance |
Foreign Travel Insurance |
Foreign Travel Insurance |
|
K |
L |
M |
N |
|
Hospitalization and preventive care paid at 100%:
other basic benefits paid at 75% |
Hospitalization and preventive care paid at 100%:
other basic benefits paid at 75% |
Basic, Including 100% Part B Coinsurance |
Basic, Including 100% Part B Coinsurance, except
up to $20 copayment for office visit, and up to $50 co payment for ER |
|
50% Skilled Nursing Facility Coinsurance |
75% Skilled Nursing Facility Coinsurance |
Skilled Nursing Facility Coinsurance |
Skilled Nursing Facility Coinsurance |
|
50% Part A Deductible |
50% Part A Deductible |
50% Part A Deductible |
50% Part A Deductible |
|
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Foreign Travel Insurance |
Foreign Travel Insurance |
|
Out-of-pocket limit $(4440): paid at 100% after
limit reached |
Out-of-pocket limit $(2220): paid at 100% after
limit reached |
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* Plan F also has an option called a high deductible Plan
F. This high deductible plan pays the same benefits as Plan F after on has
paid a calendar year ($2000) deductible. Benefits from high deductible plan
F will not begin until out-of-pocket expenses exceed ($2000). Out-of-pocket
expenses for this deductible are expenses that would ordinarily be paid by
the policy. These expenses include the Medicare deductibles for Part A and
Part B, but do not include the plan's separate foreign travel emergency
deductible.
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