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The Williamson group, LLC

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1 The Williamson group, LLC
Medicare 2018 The Williamson group, LLC

2 What is Medicare Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). The different parts of Medicare help cover specific services:

3 There are several parts to Medicare
Medicare A – covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Medicare B - covers certain doctors' services, outpatient care, medical supplies, and preventive services. Medicare C - A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits Medicare D - Part D adds prescription drug coverage to Original Medicare

4 Medicare Costs Most individuals don’t have to pay a monthly premium for Part A because they earned 40 credits while working. This is achieved by paying payroll taxes for at least 10 years. If you don’t earn enough work credits to qualify for premium-free Part A, then you could pay up to $411 a month for coverage in This amount goes up each year. There are also deductibles and copayments associated with Part A.

5 What charges Medicare part A covers

6 Part A Hospital and Skilled Nursing Facilities
Most individuals don’t have to pay a monthly premium for Part A because they earned 40 credits while working. This is achieved by paying payroll taxes for at least 10 years. If you don’t earn enough work credits to qualify for premium-free Part A, then you could pay up to $411 a month for coverage in This amount goes up each year. There are also deductibles and copayments associated with Part A. Acute care hospitals, inpatient rehabilitation facilities, critical access hospitals, long-term care hospitals, mental health care, and inpatient care that falls under a qualifying clinical research study are all covered by Medicare Part A. Things that are not covered under Medicare Part A include private-duty nursing, a private room that is not medically necessary, a telephone and television that warrant extra expenses, and personal grooming items. Medicare Part A covers Skilled Nursing Facility (SNF) care as well. While in the SNF, the following are covered: semi-private rooms, skilled nursing care, meals, physical and occupational therapy, medical social services provided through a social worker or other social service provider, speech and language pathology services, medical supplies and equipment used in the facility, medications, dietary counseling, and ambulatory services when it is a life or death situation. In order for Medicare Part A to cover a Skilled Nursing Facility, the following must happen: First, you must have Part A and you must have days left in your benefit period. There must have been an immediately prior inpatient hospital stay that was approved by a physician. Your physician must specify that SNF care is essential. Your SNF eligibility can be impacted if there is a break in your SNF care. If you leave the SNF facility for 30 days or more, you may need to have a 3-day qualifying inpatient stay in order for Medicare Part A to cover SNF again. If there is a break in SNF care that lasts for 60 consecutive days, your current benefit period ends and a new benefit period begins. Medicare Part A also covers services in a Long-Term Care Hospital (LTCH). If the following conditions are met, you will not have to pay a second deductible for a stay in an LTCH: An acute hospital transfers you directly to the LTCH You’re admitted to the LTCH within 60 days of being discharged from an acute hospital. However, if you are admitted to a Long-Term Care Hospital after 60 days, you pay the same deductible and coinsurance that you would have paid if admitted to an acute care hospital.

7 What charges Medicare part B covers

8 Medicare Preventive benefits Medicare covers most preventive care, free of charge. In some cases, Medicare will only cover these tests if you have certain risk factors.

9 Medicare Part C Advantage Plans
What Charges Are Covered Under Medicare Advantage Plans Examples are: Aetna, Humana, and Cigna which offer plans such as HMO, PPO and Private Fee for Service (PFFS) Sample Footer Text 4/7/2019 9


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