Medicare – A Simple Concept But It Seems Like It’s Getting More Complicated
When Medicare was first passed into law in 1965, it seemed fairly simple . . . you pay a small portion of your income into the program when you’re working. Then when you retire, or at least turn 65, the government will provide a safety net of healthcare. They even expanded it to include people younger than 65 with disabilities, kidney failure, or Lou Gehrig’s disease. They later added coverage for prescription drugs for what has turned out to be a very reasonable monthly premium. This had a huge impact on older Americans. I was a junior in high school when Medicare was passed, so I was oblivious to its impact on my parents. Before it passed, they were reliant on their employer’s retirement insurance, their own savings, or help from their families if they got sick as they got old. It must have been a great relief to them to know they had this safety net.
In 1997 we added Medicare Choice, which was later changed to Medicare Advantage. It gave us an option to choose a private insurance company to administer Medicare. When the prescription drug benefit was implemented in 2006, it gave us more choices to select the plan that best fit our needs. Its immediate effect was a reduction in hospital admissions. As time went on, there were new medical discoveries that improved and extended our lives, but some were expensive and complicated to administer. Some would say that all of this is complicating Medicare, but I disagree. When we are given more choices, we can choose care that fits our individual needs and our budget. It fits into the personalized care model that is the future of healthcare rather than the one-size-fits-all concept of the past. While new drug discoveries and medical advances may complicate their administration and cost, they have proven to extend our lives and our quality of life. I think Medicare has worked great and hopefully will continue to serve us. My goal for this blog is to give some background on Medicare, just a little refresher course, and to also point out some of the benefits that might be able to help you.
Medicare is broken down into different parts.
Part A covers inpatient services such as hospital stays, nursing home and hospice care, and some home health care.
Part B covers care you receive in the doctor’s office, including some medications.
Part C, also known as Medicare Advantage, is provided by private health plans. that contract with the government to provide Part A and B benefits.
Part D covers prescription medications.
Click here if you want to know a little more about Parts A and B.
Click here if you want to see five tips on enrolling in Medicare Part D. It’s something that will help you in the open enrollment season that is coming in the fall or if you’re just now turning 65. I’ll surely remind you again as the open enrollment period gets closer that reviewing your present Part D plan and other plans that are available can save you money and access to important medications. You can find more help and information about Medicare on the Seniors Speak Out website, under the Medicare 101 tab, and the Medicare Today resources website.
There’s some other information that I want to remind you about. One of Medicare’s goals is to make healthcare available even if you aren’t in the best financial situation. The government tries to alert people who may qualify for help to pay Part D premiums or other prescription drug costs, but the system doesn’t always work. You should automatically get help with Pat D costs if you qualify for:
Full Medicaid coverage
Help from your state paying your Part B premiums (from a Medicare Savings Program)
Supplemental Security Income (SSI) benefits from Social Security
Here’s some information that may help you determine if your income and resources make you eligible for extra help.
Your situation: Income limit: Resource limit:*
Individual $17,220 $30,660
Married couple $22,590 $34,360
*What counts in resource limits?
Money in a checking, savings, or retirement account, stocks, bonds.
States don’t count: Your home, one car, burial plot, up to $1,500 for burial expenses if you have put that money aside, furniture, another household, and personal items.
If you qualify your out-of-pocket costs for prescription drugs could be:
Plan premium: $0
Plan deductible: $0
Prescriptions:
Up to $4.50 for each generic drug
Up to $11.20 for each brand-name drug
If you have questions about Part D and your eligibility, you can always go to the State Health Insurance Assistance Program (SHIP). Click here to find out how to contact the SHIP people in your state.
There’s another new wrinkle that could help people spread out the cost of their prescription drugs. While the new cap limits the amount of out-of-pocket costs to $2,000, it still might be a struggle if you are taking a very expensive drug that causes you to reach the $2,000 cap in the first month or two. That’s a lot of money to come up with in a short period of time. The new law enables the $2,000 to be spread over the 12 months. There are some kinks in the program they are working out, but this smoothing rule will limit the shock for those who are taking some expensive medicine.
Medicare has had a huge impact on our lives since it was first implemented. I think our government has made some improvements, but as you know, it has also made some changes that are damaging to the long-term health of the program. I’ll work to keep you up to date on changes to this life-changing and lifesaving program.
Best,
Thair