Medicare tip: A primer on benefits


Published: Wednesday, February 13, 2013 at 2:24 p.m.
Last Modified: Wednesday, February 13, 2013 at 2:24 p.m.

February is here, and so is Valentine's Day. As we take time to honor our sweethearts and loved ones, we should also consider taking time to review our Medicare benefits. Whether you chose a new plan during the annual enrollment period, you have maintained the same coverage, or you are new to Medicare, there are some important changes and coverage information you should know.

The following information will be helpful to current and soon-to-be Medicare beneficiaries.

Part A is often called hospital insurance because it covers your care while you are in the hospital. Part A also covers some of the costs for skilled nursing facilities and hospice.

The monthly premium for Part A is $0 if you qualify based on work quarters. There is a $1,184 deductible in 2013, an increase of $28 per inpatient hospital benefit period. Note that an overnight or longer stay in a hospital does not mean you have been admitted as an inpatient. Check with your doctor to be sure she or he has admitted you, because outpatient care is not covered by Part A.

Part B pays for doctors' services and outpatient hospital care, as well as the home health care that Part A does not cover. Medicare Part B additionally covers a number of preventive services that help you stay healthy, such as flu shots and cancer screenings. It also covers medical costs, such as laboratory tests, durable medical equipment and ambulance services.

The monthly premium has increased from $99.90 to $104.90 for those with income under $85,000 for an individual or $170,000 for a couple. The annual deductible, which is $147 and due before Medicare pays, has been increased by $7.

This excludes several free preventive services provided by Medicare. Co-pays and co-insurance will vary, so check with your plan or contact Medicare at 1-800-MEDICARE.

Medicare Part D helps cover the cost of your prescription drugs, including most injectable medicines. People with Medicare Part A, Part B, or both, are eligible to join a Part D drug plan of some kind.

Monthly premiums in 2013 will range from $15 to $127.60 or higher if your income is more than $85,000 per year. Also, before the drug plan begins to pay, you may have to meet a deductible of up to $325. Co-pays and co-insurance vary by plan.

When you select Medicare Part C, you are enrolling in a Medicare Advantage Plan. You must already have Medicare Part A and Part B, and you will receive health care through that plan. This coverage may include prescription drug coverage. These are plans like HMOs, PPOs, PFFS plans and Special Needs plans.

You will not lose your Medicare coverage by selecting a Medicare Advantage Plan. It is just another way to receive your Medicare benefits. Private insurance companies have a contract with Medicare to administer medical coverage under the same rules as Original Medicare. They also have a network of providers that you may have to see, so make sure to research all of the restrictions before joining.

Financial help

A single person with a monthly income of $1,397 and resources less than $11,800 (not including your home and vehicle) can qualify for Extra Help to pay for prescription drugs.

There are also many programs available to assist with other medical costs. You have nothing to lose and lots to gain, so check with a SHINE counselor. SHINE is the acronym for Serving Health Insurance Needs of Elders.

A listing of sites can be found at floridashine.org or you can call the Elder Helpline at 800-963-5337 to request assistance.

Margaret E. Shaw is an Elder Options/SHINE liaison at the Mid Florida Area Agency on Aging in Gainesville.

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