Senior Health care continues to be one of the biggest topics on everyone’s mind these days, both within the healthcare industry and with the general public at large. Whether it’s about what Medicare covers or when you’re old enough to qualify for Medicaid, there are many questions that come up when deciding how to approach senior health care. This guide will address some of these issues in detail, including how to decide which program is right for you and your situation and what kinds of things might disqualify you from different programs!
Various Parts of Senior Health care Medicare
Getting your head around the many Medicare parts can be a challenge. The federal government has broken it down into four sections to better manage it. Hospital stays, doctor visits, and medication prescriptions are all addressed in these four sections.
Healthcare Insurance (Part A):
Hospice care stays in Skilled Nursing Facilities (SNFs) and hospitalizations following a diagnosis of a stroke, broken hip, or other rehabilitation injuries are all paid for under Medicare Part A. Medicare will cover 100% of the cost for the first sixty days of inpatient care. However, there is a catch or two. For example, Medicare does not cover the cost of a private room.
Medicare Part A does not have a premium for the vast majority of eligible senior Health care. Because Medicare taxes have already been withheld from your paycheck, neither you nor your spouse will not have to make any further contributions. But it’s not totally free of charge, either. We’ll examine it in further depth in the sections that follow.
Part A premiums allow U.S. citizens and permanent residents who have not worked long enough to qualify for Medicare to join the program.
Services rendered by physicians and other medical professionals (Part B):
This part of Medicare pays for non-hospital medical treatment received outside of a hospital, including doctor’s visits, lab work, diagnostic screens, medical equipment, and ambulance transports. In contrast, preventative care services are fully covered under Part B. It pays a predetermined sum to doctors and hospitals that take Medicare patients. To receive Medicare Part B benefits, you must pay a monthly premium.
Medicare Advantage (Part C):
Medicare Advantage (M.A.), a substitute for Original Medicare, includes health and medication coverage. Its certification is handled primarily by a commercial company. The Original Medicare Program (Parts A, B, and D) are all included in M.A., making it a “bundled” plan. To receive coverage, you often need to see one of the in-network providers.
Prior to 2003, M.A. was known as Medicare Plus Choice (M+C), but since then, it has been referred to simply as Medicare Part C., Affordable for retirees.
In order to remain in good standing as a Medicare Advantage Plan participant, some guidelines must be adhered to. For instance, you may only be eligible for services available in your geographic area, and coverage terms may change based on your current health status. On the other hand, Medicare Part C will cover a large portion of the costs associated with maintaining your health and treating both acute and chronic conditions.
The following are other items that are covered by Medicare Part C:
- Preliminary Results From Lab Tests
- Acute treatment
- Going to the Doctor
- Heart-related therapy
- Casts and splints
Prescription Drugs (Part D):
Part B of Medicare covers the cost of some of the medications you choose, whether generic or brand name. Medicare Part D includes a variety of premium plan options and yearly deductibles. Part D is still overseen and controlled by the federal government, but private insurance companies set the regulations for what is covered. Plans vary regarding; for instance, the medications paid for and whether or not brand-name or generic medications are paid for.
Original Medicare vs. Medicare Advantage
The fact that commercial insurance companies offer M.A. plans is a major differentiator between Original Medicare and Medicare Part C. When compared, Original Medicare is overseen by the federal government. Read on for a quick comparison of Medicare and Medicare Advantage.
The Medicare Supplement Program is sometimes commonly referred to as “Medigap.” Exactly as the name implies, this type of insurance is meant to supplement or fill in the gaps left by Original Medicare. Private insurance companies offer Medigap policies but are governed by federal and state guidelines.
Medigap mandates uniformity among insurance companies within a state for its supplemental policies. As a result, comparing prices is much less complicated. Furthermore, Medigap plans no longer cover prescription drugs as they did before 2006.
Medigap policies may also include benefits that are not available through traditional Medicare. Insurance for medical treatment while traveling abroad, for instance, or for private nursing, vision care, dental care, or hearing aids.
Enrolling in a Medigap policy is against the law if you are already enrolled in a Medicare Advantage (M.A.) plan unless you are moving to Original Medicare. If you are enrolled in a Medicare Advantage Plan and also have Medigap, you may want to consider dropping Medigap. Due to the additional coverage that Medicare Advantage plans offer, you cannot utilize Medigap to cover the costs associated with your Medicare Advantage Plan’s copayments, deductibles, or premiums.
What is the Medicare process for paying for assisted living?
If you want to utilize your Medicare benefits to pay for assisted living, you’ll need to submit proof that the necessary medical care was delivered within the facility itself. If the assisted living facility you’re considering accepts Medicare, ask for a detailed list of its services so you know exactly what to expect.
Does Medicare pay for nursing home stays?
Medicare Part A helps pay for nursing home care when it’s medically necessary, and a Medicare-approved facility gives it. Thus, nursing home care is covered if it is required to diagnose or treat illness, accident, disease, or other medical condition. However, Medicare will never pay for custodial (non-medical) senior health care. Therefore, a nursing home stay will not be covered if only minimal care is required.
Senior Health care is a complicated system. It’s complicated because it involves many different types of people, issues, and ways to approach them. However, the more you know about how healthcare works, the better equipped you’ll be to make decisions that can improve your health and save money in the long run!
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