by Kristin P. Sinclair February 7, 2020
Medicare has unlimited out of pocket exposure. Therefore it is important that you the Medicare beneficiary have coverage above and beyond that of the original Medicare. Supplemental coverage can help pay for that additional out of pocket exposure and different plan designs offer different levels of coverage. This supplemental coverage includes Medicare Supplements and Medicare Advantage Plans.
Please note that only Medicare Supplements are guaranteed for life. You can call Kristin at (803)329-0615 to review your coverage options than can help reduce your out of pocket exposure.
Medicare Part A
Medicare Part A in 2020 has a $1,408 Hospital Admission Deductible for inpatient services. That $1,408 is applicable whether you are admitted for one day, or up to 60 consecutive days. On days 61 through day 90 the Medicare beneficiary would have a co-payment responsibility of $352 for each day. Days 91 through 150 are one-time use Lifetime Reserve Days the Medicare beneficiary would have a co-payment responsibility of $704 for each day. At day 151 Medicare would have paid as much toward that particular admission/hospital stay as can be paid by the original Medicare.
A Medicare beneficiary might have more than one hospital admission during an annual period. Unfortunately then you are responsible for more than one $1,408 deductible, plus potentially multiple co-payments !
Medicare Part A might pay the first 20 days for a skilled nursing facility stay if all of the following requirements are met:
a.) Preceded by a 3 day inpatient hospital stay
b.) Admitted to the skilled nursing facility within 30 days after the 3 day inpatient hospital stay
c.) The skilled nursing facility stay is for the same reason associated with the 3 day hospital stay.
If all of the above apply, then for days 21 through day 100 the Medicare beneficiary would be responsible for the first $176 per day for that skilled nursing facility stay. Medicare would should then pay the amount above the $176 per day for the days of 21 through 100. After the 100th day of continuous skilled nursing facility care Medicare would not pay for any additional days. Medicare does NOT pay for Long Term Care.
Medicare Part A does not pay for the first three pints of blood, however, after the first three pints of blood Medicare would pay for Medically necessary additional pints while in the Hospital.
Medicare Part A pays for all but limited co-insurance and co-payments for outpatient drugs while in Hospice Care. As well as limited inpatient respite care. Note: the intention of Hospice Care is to provide quality of life care at the end of life, but Hospice Care is not intended to extend life, or help the patient recover from an illness. The Patient must meet Medicare requirements for admission to Hospice for end of life care.
Medicare Part B
Medicare Part B in 2020 has a deductible of $198 which is a one-time annual deductible. Followed by 20% co-insurance for the Medicare negotiated rate, which calculated at 20% of the Medicare approved rate. The Medicare beneficiary may also be responsible for any excess charges as well. Excess charges would be associated with a Medicare covered charge that is provided by a Medicare provider. This provider agrees to see Medicare patients; however, this provider has charges that could be up to 15% higher than Medicare approves. If the medical treatment is not a Medicare Part B approved service the Medicare beneficiary would be responsible for the total charges associated with that medical care being received !
Any time you are receiving medical care, the medicare beneficiary should inquire as to whether the medical care is a medicare covered service. Thus, you the Medicare beneficiary can make the necessary financial associated with your care. Concierge services are an example of medical care that normally is not covered by Medicare.
Medicare Part B does not cover the cost associated with the first 3 pints of received for out-patient services. Medicare Part B should cover the cost of blood over and above the 3 pints. Of course based upon medical necessity, and the Medicare beneficiary for their cost sharing responsibility.
Medicare as a general rule will pay the charges associated with medically necessary Skilled care services received at home and medical supplies associated with the skilled care. This care is being considered medically necessary while recovering. While returning to an improved level of health. Medicare does not offer unlimited Skilled Care in the Home setting. After a period of care if improvement is not being realized the Skilled Level of Home Care would no longer be considered Medically necessary and would end. It is also important the Medicare Beneficiary is aware that, Medicare Part B does not covered other levels of non skilled care, associated with at home care. Medicare Part B has cost sharing associated with Durable Medical Equipment. Such as the Annual deductible of $198 if not already met as well as the 20% co-sharing co-insurance amount.
The Medicare Beneficiary should receive the Durable Medical Equipment from a Medicare approved preferred provider to save as much out of pocket exposure for any Durable Medical Equipment. The Medicare approved preferred provider will go over proper use of the durable medical equipment as well. You can research available preferred providers by referring to the Medicare.gov available resources.
Medicare pays nothing for Medical care received outside of the United States or the U.S. protectorates. For more on this topic the Medicare beneficiary should review the information available at Medicare.gov.
Original Medicare has preventative care services that are covered events and a list of those services provided will be covered in a separate article. You can also review these covered items by referring to the Medicare.gov publications available on line.
Kristin P. Sinclair
Updated in Charlotte NC and Rock Hill SC
February 7, 2020