Part A - Mechanics
MR. WATSON: Let's talk about Part A & how its works. And remember, the numbers that I give you, as always, are just to illustrate. You know, if you want to know the true numbers, look them up, but the numbers themselves are not important. The number of days I tell you is accurate, but the monetary amounts are just examples to illustrate the point.
MR. WATSON: Medicare Part A is a 90-day program, broken into a 60 day period and a 30 day period. For the first 60 days, when you go in the hospital, you pay a deductible of about $1600. Medicare pays the rest. Does that make sense?
ALL: Yes.
MR. WATSON: Then for the 61st through the 90th day, you pay approximately $400 a day. What happens if you are in there longer than 90 days? Everybody has 60 lifetime reserve days. You would draw from your 60 lifetime reserve days.
- A benefit period begins when you go in the hospital.
- It ends when you have been out 60 consecutive days.
So, you can have more than one benefit period in a given year. Your life-time reserve days are never replenished. Once you use them, they are gone.
MR. WATSON: Let me explain. Let's say you were in the hospital for 30 days. If you go home and you're home longer than 60 days and go back in, your benefit period starts all over again. (You would have to pay another deductible). The key is 60 days. Right? But if you are home less than 60 days and you go back in, you pick up on day 31 as if you'd never left the hospital.
MR. WATSON: So for the first 60 days you pay a deductible, around $1,600. Medicare basically pays the rest. We're not talking about the doctors. Just the hospital. The next 30 days, which are days 61 through 90 that you’re in the hospital, you pay $400 per day and Medicare pays the rest.
MR. WATSON: But if you are in there longer than 90 days, you would have 60 lifetime reserve days. So if you are in there, say, for 95 days, for the 91st through the 95th day, you can draw from your lifetime reserve days. But then you have to pay is close to $800 per day for each day you use your life time reserve days. Medicare would pay the rest. That's a lot of money. We're not even talking about the doctors, are we? No.
Hospice Care
MR. WATSON: Medicare Part A covers hospice care for terminally ill patients and their families. It covers skilled nursing care in a hospice facility or at the patient's home. It covers medications for pain relief and symptom management. Benefits are unlimited, but a doctor must certify that the medical condition is terminal and death will occur with-in seven months. It also covers respite care for caregivers and home health aides.
Student: Wow!!!
MR. WATSON: What about "home care"? Medicare Part A pays for only 20 days.
Home Care
It covers:
- intermediate care, or
- physical, occupational, or speech therapy in a home setting.
- It also covers home health aides, medical social services, medical supplies, & the rental of the medical equipment, (the walker).
Medicare Part B
- requires a premium
- requires a deductible
- 80/20 co-insurance
MR. WATSON: Medicare Part B. You have to pay for it, $165.00 a month. Medicare Part B has an annual deductible, around $225. Again, the dollar amounts don’t matter. Just know that there is a premium and deductible. Then Medicare would pay 80 percent, and you would pay 20 percent. So, they pay a percentage, 80/20. The Part B deductible is raised annually by the same percentage as the Part B premium. Higher income Medicare beneficiaries pay a higher premium. The higher the income, the higher the premium. Wow!
MR. WATSON: Which part of Medicare pays a percentage of the benefits?
ALL: Part B.
MR. WATSON: The chart below show the nine (9) gaps or exclusions in Medicare. Know these. Make flash cards.
Primary and Secondary Payor
MR. WATSON: Anybody age 65 or over who is still working for an employer with 20 or more employees is by law entitled to the same health benefits as the employer offers to its younger employees. In this case, Medicare would be the secondary payor; the employer's health plan would be the primary payor.