With the recent health reform and talks about more restructuring, health insurance is a cloud of confusion for everyone. It is especially important for seniors to understand the benefits and limitations of Medicare. Many retirees find Medicare’s plans puzzling, and choose to wait until their first hospital visit to address it. However, learning about your insurance when the time comes to pay for it could add additional stress to already existing stressful time.
Here are some pointers for understanding Medicare. Remember this is a general guideline. For detailed information on your plan you should contact your provider and speak with a representative.
Medicare Basics
If you are 65 years or older you are entitled to Medicare benefits. There are generally two parts to the average Medicare Plan: Part A and Part B.
Medicare Part A – pays for inpatient care in a hospital or skilled nursing facility, some home care, and some hospice care.
Medicare Part B – helps to pay for doctor’s services and other medical needs that are not covered by Part A. Part B can be deferred if the beneficiary or his/her spouse is working. There is a lifetime penalty (10% per year) imposed for not enrolling in Part B unless actively working
Be Aware of Medicare Advantage Plans
Some individuals may opt for Medicare Advantage Plans which is Medicare coverage that works in conjunction with private insurance (ie. Secure Horizons). Many people in these programs forget Medicare Advantage Plans have a group of in-network providers that they must use. Any doctor not in-network with the given plan is considered out-of-network and the patient must pay an out-of-network cost to see the doctor. If it is an out-of-network private practice, patients may even be turned away and referred to another doctor.
So, be sure if you are seeing a specialist and you would like to continue your relationship with them, it is best to inquire which Medicare Advantage Plans they are in before signing up for an Advantage Plan.
What is Supplemental Insurance?
While Medicare is very comprehensive, not everything is covered. For example, if Medicare covers 80% of a procedure, the supplemental insurance will step in and cover the other 20%. This may vary according to each supplemental insurance plan as well as the premiums paid. It is important to research the possibility of adding supplemental insurance well before it is needed, as many seniors are surprised when they are reimbursed for only a portion of their hospital bill.
Work with Your Doctor’s Administrator
A majority of health facilities have an administrator and insurance specialist. If you are retired and live near a hospital you would like to frequent in the future, you can call an insurance specialist at the facility to find out which providers they are in-network with. These specialists are also acquainted with procedural billing and may be able to help you calculate how much of a procedure is covered and how much you will have to pay out-of-pocket.
Do Your Research
Keep up to date on health care reform and changes in Medicare policies. A great way to do this is by researching online websites which are updated frequently.
AARP’s Medicare section is straight-forward and updated frequently:
http://www.aarp.org/health/medicare-insurance/
To refresh your mind on Medicare basics, take a look at their Wikipedia pages:
http://en.wikipedia.org/wiki/Medicare_(United_States)
Medicare’s General Website should be your go-to:
http://www.medicare.gov/
Trouble understanding bills and reimbursements? Free Medicare counseling can help:
http://www.cahealthadvocates.org/HICAP/
Join Valencia Terrace for the "Medicare Made Clear" seminar on Wednesday, October 20th. We will be discussing the changes in our healthcare system and will be available to answer any of your questions!
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