The following video answers the question... What Is Medicare and how do parts A, B, C and D affect you as a Medicare participant?
Hello, my name is Craig Prince, CAP Insurance Services. I would like to take you through the A,B,C,D’s of Medicare and other words. I would like to talk to you about how Medicare works.
I think this picture really represents the confusion that seniors feel, and it's a look that I often get when seniors come to me. The two items that they respond to us with are:
- Medicare is just too confusing
- Part A, Part B, Part C, Part D, HMO, PPO, Deductibles, Co-pays, Medicare, Supplements and Medicare advantage. And then of course, plans A, B, C, D, E, F, G, H. In other words, all the plans that are available, through plan N and Medicare supplements.
And so, which way to go and which plan is right for me? That's the ultimate question. In fact, it's a question I get up front before I even have an opportunity to speak with people. So, what I would like to do today is to basically share with you how Medicare works and give you an understanding of Medicare.
And before I do that, basically I'd like to talk to you about who I am.
If I haven't already told you, my name's Craig Prince with CAP Insurance Services. I've been in business for over 40 years. In fact, some of my first Medicare clients were born in the 1890’s.
So, what I like to tell people is that nowadays, I possibly could be talking to you about Medicare and that I had already talked with your grandparents about it. At our agency, I represent all major Medicare supplement carriers and also represent over nine Medicare advantage companies in the California area and other states.
Basically, our approach considers your relationship with your primary care physician first. Then, it takes into consideration your needs based on your prescriptions and then the consideration of plan benefits.
Now, this approach is going to save you time and get you the coverage based on your needs. And so, it doesn't matter if your friend or your neighbor has, you know, ABC plan.
Let's say, if your neighbor has scan, scan may be the plan for you. It may not be. So, we want to make sure that based on your needs, you're going to have the very best coverage that's available.
There are four parts to Medicare, there is Part A, Part B, Part C and Part D, Parts A and B you get from Medicare and Part C and D you get from insurance companies.
Medicare Insurance Card
And you can see an example of a Medicare card, which in 2018 they changed the Medicare card so that your Medicare claim number is no longer your social security number followed by a letter. It now is what we call an encrypted number, so that number is specific to your Medicare, but nobody is able to steal your identity using your social security number.
And, so down below you see hospital Part A, and the effective date is typically the first of the month you turn 65, and then Part B is the medical insurance. And, it again typically will have a start date of the first of the month that you turn age 65.
There are some exceptions to that rule, but that is general rule and that's what will go on.
Today specifically, we're going to talk about Part A, talking specifically about how it works so that you have an understanding of what it covers and also what it doesn't cover.
I want to say upfront that Part A for most people will not cost any premium. That's important to understand. When I say for most people, what I mean by that is that if you have paid into social security and part of your social security tax was your Medicare surtax. When you paid into that, it entitled you to the benefit of Part A.
In other words, as long as you've worked at least 40 quarters (which is 10 years) and paid into the system, Part A will not cost you any money.
Medicare Part A
There are four aspects of Medicare Part A.1. Inpatient Hospital Copay
So in 2018, that inpatient hospital copay is going to be, or currently is $1,340. So here's what I like people to understand. If you were to be taken to the hospital today, assuming that you're on Medicare today and you go into the hospital, whether you're in the hospital as an inpatient for one day or up to 60 days, Medicare is going to pay all the bills other than the first $1,340.
Now, that $1,340 is known as a copay. And, what I mean by that is that if you came out of the hospital for 60 days and then you went back in the hospital, you would have another $1,340.
Sometimes people like to say, well then is that a deductible? But deductible kind of indicates that once you're done, it's done for the year, which in Medicare on this inpatient hospital copay, it is paid each time that you go in, if you have separation of hospitalizations of more than 60 days.
There is a copay from the 61st to the 90th day and from the 91st to the 150th day. However, with this first 60 days, it starts over again each time you go into the hospital. I've never had a client in my 40 plus years in the business who have gone beyond 60 days.
In fact, I haven't had anybody come close to that. Typically, what happens is they will take you out in a wheelchair through the front door before that occurs, or you're going to be wheeled out the side door on a Gurney, but nobody stays in the hospital 60 plus days.
2. Skilled Nursing Facility
So, if a person goes into the hospital under Medicare and they're there at least three days, if the doctor says, "You know you're not sick enough to be in the hospital, but you're not well enough to go home, you would then get transferred from the hospital to a skilled nursing facility."
A skilled nursing facility is a facility where you can receive physical, occupational, or speech therapy. And in that skilled nursing facility environment, you can receive it at a whole lot less cost than being an inpatient in the hospital.
And here's what Medicare says, "As long as the facility that you're going into is contracted with Medicare (has a contract with Medicare) and as long as Medicare allows the confinement from day one to day 20, Medicare will pay that confinement in full from the 21st day to the 100th day. Medicare will pay all but $167.50 each day. Okay? And then of course, there's no coverage after the hundred days.Blood Transfusions
Medicare also says that if I am in the hospital as an inpatient and if I need a blood transfusion, they will pay all the costs of that inpatient blood transfusion after you as an individual have paid the cost of the first three pints of blood.
The first three pints of blood would vary from hospital to hospital, but you can be looking at $300 to $500 per pint.Hospice Care
The fourth aspect of Part A is hospice care. Hospice care is the care that you receive when you're ready to die. What they typically do is want to make you feel comfortable. So, whether your hospice care is received as an inpatient in a hospice care facility or if it's received at home, Medicare will pay 100 percent of the cost and you won't have to worry about that.
Now, there is a couple of items I want you to note as it deals with the emergency room and if I was treated in the emergency room, but my visit to the emergency room does not end up in inpatient confinement. That emergency room visit actually would be a Part B charge, not a Part A charge. Even though the emergency room is attached to the hospital, that charge is going to be considered a Part B.
Same thing happens with outpatient surgery. If I go into the hospital, let's say I have a hernia surgery, so I go into the hospital in the morning, I have the surgery, I recoup and then I come home that same day, that hospital charge for my outpatient surgery, plus my surgeon, my assistant surgeon in my anesthesiologist charges for that surgery are all going to be paid under Part B of Medicare. Not Part A.
What is Covered Under Medicare Part A:
- Inpatient hospitalization
- Inpatient skilled nursing facility
- Blood transfusions
- Hospice Care
I'd like you to know, as a Medicare Insurance Agent, how seriously I take my responsibility in being your guide through this Medicare maze.
What I hope at the end of the process of explaining the ABC’s of Medicare is that first of all you'll feel very relaxed and then the next feeling is I hope that you have is a feeling of empowerment that you're now prepared to make a good decision to get a plan that is going to best suit your needs.
I’ve been doing this for 40 years. I never get tired of seeing that happen for my clients and I'd like to do that for you.
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