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November 6, 2003 Saugus Advertiser
MEDICARE, MEDIGAP AND MEDICARE + CHOICE
These are all names of health insurance plans for seniors. Today, I’d like to explain exactly what each of these plans are to help you make decisions about your health insurance coverage.
MEDICARE - The Medicare Act was signed into law in 1965. This health insurance coverage is available to most people over the age of 65 who are entitled to receive Social Security. If you are not entitled to receive Social Security because you had less than 40 quarters of Medicare-covered employment, Medicare Part A can be purchased for a monthly premium of between $189 and $343.
Beginning in 1998 Medicare was divided into three parts known as Medicare Part A (hospital insurance), Medicare Part B (Medical Insurance) and Medicare Part C (Medicare + Choice).
Medicare Part A covers all the cost of inpatient hospital for the first 60 days subject to a $876 deductible and partial coverage for hospital stays over 60 days and up to 150 days. Your expenses under Medicare A are as follows:
· $876 for hospital stay of 1-60 days
· $219 per day for days 61-90 of a hospital stay
· $438 per day for days 91-150 of a hospital stay
· All costs for each day beyond 150 days
There is also a limited coverage for nursing home care provided that you spend at least 3 nights in a hospital prior to being admitted to the nursing home. For nursing homes you get full coverage for days 1 to 20 and for days 21-100 there is a $109.50 per day deductible. Certain Medigap policies will pay this $109.50 per day deductible. It is also worth noting that although you may receive up to 100 days of coverage, many do not. Medicare coverage of nursing home stays is dependent on your physical condition. You must show signs of improvement to stay on Medicare. If your condition is level or deteriorating, Medicare coverage can stop at any time.
Medicare Part B is optional insurance which covers doctors services and a portion of certain doctor prescribed equipment. There is a $100 deductible per year and after that you pay 20% of the Medicare approved amount. The monthly premium for Medicare Part B is now $66.60, up from $58.70 last year.
Medicare Part C – Certain companies contract with Medicare to provide Medicare health plans. These are called Medicare + Choice (Medicare plus Choice) plans. Secure Horizons is an example of a Medicare + Choice plan. These plans get their money from Medicare and may charge an additional premium. These plans generally have a smaller out-of-pocket cost and extra benefits such as prescription coverage, eye exams and routine physicals. They do restrict you to seeing a doctor who is a member of the plan. You should weigh the benefits of these extra services against the additional cost and convenience in deciding which plan to choose. To find a list of the plans available you can check the “Medicare Personal Plan Finder” on the Medicare web site located at www.medicare.gov.
Medigap Policies – A Medigap policy is a supplement to your Medicare coverage offered by various health insurance companies such as Blue Cross Blue Shield. Depending on the amount of coverage that you select the premiums can range from $72 to $418 per month, per person. A list of plans available can be found at the Medicare web site mentioned above.
Help is available. If you have questions and need help in figuring out what health insurance options are available to you, call Nancy McKenzie at the Outreach Department of the Senior Center at 781-231-4178.
This article gives general information and not specific advice on individual matters. Persons wanting individualized advice on matters discussed should contact an advisor experienced in those matters. To the extent this article provides information on legal matters, it is based on law in effect in Massachusetts on the date of posting (laws in effect in other states are often quite different).
Ronald H. Surabian is a CPA and attorney who works at the Elder Law Center in Saugus, Ma. He also holds a masters in accounting and a masters in tax law. He currently serves on the board of directors of the Massachusetts Chapter of the National Academy of Elder Law Attorneys.