| The lowdown on Medicare coverage |
|
|
As with Part A, Part B has its own separate
annual deductible -- $135 for 2008 -- as well as its
own co-payment and co-insurance costs. Generally speaking,
Medicare will pay about 80 percent of the expenses
for Part B-covered services and supplies.
"People expect that Medicare will provide
them with health coverage after they retire, and that's
true -- Medicare is comprehensive, it's guaranteed.
But it doesn't cover all of your costs," says Paul
Precht, director for policy and communications at
the Medicare Rights Center.
"You need to be aware of the fact that
you will spend money out of pocket, either for the
cost-sharing under Medicare, or for the cost of supplemental
insurance if you don't have that through an employer
or if your income isn't low enough to qualify for
additional assistance through Medicaid. And it's important
to remember that Medicare doesn't have any annual
out-of-pocket limits."
You usually don't pay a monthly premium
for Part A coverage if you (or your spouse) paid Medicare
taxes while working at least 40 calendar quarters.
But if you aren't eligible for premium-free Part A
coverage -- meaning you have worked fewer than 40
calendar quarters -- you may be able to buy Part A
coverage if you meet certain conditions.
Those enrolled in Part B have to pay
a monthly Part B premium and an annual Part B deductible.
Most plan participants will pay the standard monthly
premium amount, which is $96.40 in 2008. The monthly
premium amount, however, will be higher for people
above certain income thresholds ($82,000 for singles;
$164,000 for married people filing jointly). Financial
hardship cases can get this premium covered with governmental
help. This premium is deducted from your monthly Social
Security payment.
Medicare Part C: Medicare Advantage plans
Formerly known as Medicare+Choice, Medicare Advantage
plans are alternatives to the original Medicare plan
and are not the same thing as "supplemental insurance"
(more about this later). Sometimes called Part C or
"MA plans," these plans are run by private companies
and are part of the Medicare program.
Basically, Medicare pays an amount of
money for your health care into these private Medicare
Advantage plans every month. In return, these plans
must provide all of your Part A and Part B benefits,
and they must cover at least all of the medically
necessary services that the original Medicare plan
provides.
MA plans can charge different co-payments,
co-insurance and deductibles for their services and
generally have set provider networks. This means you
will likely be limited to seeing only those doctors
who belong to the plan, going to certain hospitals
for covered services and getting referrals to see
specialists. If you use providers who aren't in the
network, you may have to pay the entire cost of the
services rendered. However, MA plans can offer extra
benefits, such as vision, hearing, dental, and health
and wellness programs. Most include Medicare prescription
drug coverage (usually for an extra cost).
Retirees can currently choose from five
different types of Medicare Advantage plans. Most
function like HMOs with specific networks of doctors.
Other plans, such as Private Fee-For-Service plans, or PFFS, will allow you to go to any doctor if the
doctor agrees to accept the plan's terms of payment
before treating you. Medicare Special Needs plans, or SNPs, serve certain people who are chronically ill,
live in institutions such as nursing homes or have
other special needs. (The different benefits offered
by the various types of Medicare Advantage plans are
outlined on pages 42 to 44 of the "Medicare & You 2008"
handbook.)
|
