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Product Details
| ISBN-13: | 9781504905275 |
|---|---|
| Publisher: | AuthorHouse |
| Publication date: | 04/10/2015 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 126 |
| File size: | 424 KB |
Read an Excerpt
The Medicare Survival Guide
2015 Edition
By Diane Daniels, Norma Jean Lutz
AuthorHouse
Copyright © 2015 Diane DanielsAll rights reserved.
ISBN: 978-1-5049-0526-8
CHAPTER 1
The History of Medicare
Today, nearly 50 million Americans depend on Medicare for their health insurance coverage. That amounts to about 15 percent of the nation's population.
Medicare is the Federal Health Insurance Program for people age sixty-five and older, as well as people with certain disabilities, and people with end stage renal disease (a.k.a. kidney failure). The program is administered by the Federal government and financed through payroll taxes and fees paid by the beneficiaries themselves.
In 2015, Medicare will be celebrating its 50th Birthday. It's hard to imagine that 50 short years ago, Americans over the age of 65 were on their own to pay for healthcare. I can't fathom the fact my grandparents paid for their own healthcare, during a time they needed help the most. These were the same men who fought in a massive war while the nation slept at night, and the women on the home front ran the home and raised the children. I'm glad my grandparents lived to receive benefits from Medicare. My parents are receiving Medicare benefits, and I'm looking forward to the benefits of Medicare when I turn 65.
In my Brooklyn memories, I can remember my great-grandmother, Nanny, at the first of every month watching out the front windows, eagerly awaiting the mailman.
"Check should be coming today," she'd say.
Pretty soon I would hear, "Hear he comes!" Hurrying to the front door, she went out on the stoop to wait. I could hear her trading cordial words with the mailman. Shen then closed the door, walked to her favorite green chair, sat down and riffled through the mail until she found what she was looking for.
"Here it is," she shouted. I knew what was coming next; this was a ritual I'd seen many times before. Pulling the check from the envelope, Nanny stood up to dance a little jig. "I love you my baby boy," she sang.
Nanny kissed the check and then held it close to her cheek and fondled it like it was a newborn. "Thank you for everything, my boy."
Nanny was talking about her youngest son Tommy. I never met my great-uncle Tommy, but I knew much about him. At the young age of 19, he enlisted into WWII where he served as a bombardier in the Air Force. He flew 19 missions after which he'd written to Nanny telling her he was on his way home. He had one more mission – one he volunteered for. That was his last mission; Tommy never made it home. His plane was shot down over Germany.
Nanny had no pension; she had no money in annuities or investments, so quite literally that monthly check helped Nanny survive.
Today, in a similar fashion, Medicare has become a lifesaving factor for many of our senior citizens. In this chapter, we'll take a look at how all of this came about.
(NOTE: From an early age, my Nanny taught me to respect veterans. She impressed upon me the high price they paid for our basic freedoms in this country. Stories about Uncle Tommy helped me appreciate what freedom truly means. Nanny helped me to become aware that I was free to play outside, or I could watch TV, I could attend the church of my choice, and I could be whatever I chose to be when I grew up – all because of those who were brave enough to defend that freedom. That honor and respect remains with me to this day. Thank you, veterans.)
Signed into Law
On July 30, 1965, President Lyndon Baines Johnson signed Medicare into law under Title XVIII of the Social Security Act. The signing ceremony took place in Independence, Missouri at the Truman Library.
Former President Harry S. Truman sat at the table while the law was signed.
President Johnson held the ceremony there to honor Truman's leadership on health insurance, which he first proposed in 1945. President Truman had attempted to bring Medicare to fruition during his presidency, but there wasn't enough support. President Kennedy picked up the ball and ran with it. President Johnson signed Medicare into law. President Truman was also the first beneficiary to enroll in Medicare; however, he wouldn't start receiving his benefits until July of 1966.
Two Parts to Original Medicare
The original Medicare had two main components – Part A and Part B. Part A included inpatient hospital services and Part B included outpatient services.
Medicare services didn't actually begin until July 1, 1966. More than 19 million American citizens were eligible to enroll. 93% of those Americans enrolled in the Medicare program that took a little over a year to begin services. It wasn't easy to persuade the first qualified beneficiaries of the Medicare program to enroll. According to an article written by Washington Post journalist, William Raspberry, the government hired over two thousand workers to go door-to-door in an attempt to enroll Americans aged sixty-five and older.
The earliest Medicare beneficiaries paid a $40 deductible for Part A.
After a beneficiary paid their Part A deductible, Medicare would pick up the remaining bill for medically needed services. After a beneficiary's annual Part B deductible was paid, the beneficiary would pay 20% of the Medicare allowable services and Original Medicare would pay the remaining 80%.
Moving forward to present day, beneficiaries pay a $1,216.00 deductible for Part A.
Part A, the inpatient insurance, is provided at no charge to most eligible beneficiaries. Part A is funded by revenue from a 2.9% payroll tax levied on employers, employees, and the self-employed. Part A of Original Medicare is also funded when Original Medicare beneficiaries pay their deductibles and co-insurances for treatment.
Beneficiaries who voluntarily enrolled in Part B paid a monthly premium of $3.00, which President Truman paid with his enrollment. This was estimated to be enough to fund 50 percent of Part B costs, and federal general revenues covered the remainder.
Part B is for outpatient services. Part B covers services such as - doctor visits, x-rays, blood draws and outpatient surgery. I will talk more about Part B services in Chapter 2. Currently, beneficiaries whose income is less than eighty-five thousand dollars a year, pay a monthly premium of $104.90.
In 2006 a surtax was added to the Part B premium for higher-income seniors (annual incomes over $85,000.00). Below lists the 2015 Part B monthly premiums for an individual.
If your annual income is:
a. Over $85,000 dollars up to $107,000 dollars - Your Part B Premium is $146.90
b. Over $107,000 dollars up to $160,000 dollars - Your Part B Premium is $209.80
c. Over $160,000 dollars up to $214,000 dollars Your Part B Premium is $272.70
d. Over $214,000 dollars -Your Part B Premium is $335.70
You can contact Social Security to determine your Part B Premium.
Notable Amendments
The Social Security Amendments of 1972 authorized an expansion of Medicare. The act granted benefits to those people under 65 who receive Social Security disability cash payments for at least 24 months. The act also added people with end-stage renal disease who require maintenance dialysis or a kidney transplant.
The Balanced Budget Act of 1997 was signed into law by President Clinton on August 5, 1997. Beneficiaries could remain in the Original Medicare program or enroll in the newly formed Medicare Part C, "Medicare + Choice" privatized by health insurance management. Medicare + Choice began to offer expanded private plan options to Medicare beneficiaries.
The Medicare Modernization Act of 2003 was signed by President George W. Bush. Medicare Part D, also called the Medicare Prescription drug benefit, began in January 2006. Medicare Part D helped subsidize the costs of prescription drugs and prescription drug insurance premiums for Medicare Beneficiaries.
Another Interesting Fact About Part A
Medicare funds the vast majority of medical school residency training in the US. This tax-based financing covers resident salaries and benefits through payments called Direct Medical Education or DME payments. Medicare supports teaching hospitals with over $8 billion per year for their Graduate Medical Education, while Medicaid funds over $2 billion. The Department of Defense, the Veterans Administration, and private payers also pay for portions of resident physician education.
Medicare also uses funds for Indirect Medical Education or IME payments, a subsidy paid to teaching hospitals that is tied to admissions of Medicare patients in exchange for training resident physicians in certain selected specialties.
Next time you visit your primary physician, ask them where they did their residency. If the hospital is a teaching hospital it's more than likely Medicare helped pay for your doctor's residency program.
Now that we've covered a brief history of Medicare, let's take a more in-depth look at the different Parts of Medicare.
CHAPTER 2Do You Know Your A, B, C and Ds?
PART A
The Hospital Insurance
Sarah Kellogg Contacts Me
A lady named Sarah Kellogg contacted me asking for assistance concerning her 70-year-old husband, Jack. Sarah is 62 and still works full-time as a medical receptionist at a private practice, but she's getting ready to retire in six months. Sarah's current private health insurance includes Jack on the policy. Her dilemma is that she doesn't know what to do for Jack when her private insurance policy ends at retirement.
"Has Jack enrolled in Medicare?" I asked.
"He's enrolled in Part A, but not Part B," Sarah told me.
"How long has Jack been on your employer's health insurance plan?"
"For the past twelve years."
"That's great!" I said.
Since Jack has already turned 65, he's entitled to enroll in the Medicare program. I learned Jack had worked for ten consecutive years and paid FICA taxes. That entitles him to enroll in Medicare Part A with no premiums attached. He can enroll in Medicare Part A, but Part B is optional. If Jack wishes to enroll in Part B, he'll be required to pay a monthly premium (currently at $104.90 a month). Jack will also be required to pay the annual deductible of $147.00 before Part B benefits kick in. Jack will be responsible for 20% of the Medicare allowable bill. Medicare will pay the remaining 80%.
Deferring Part B
Jack is on credible health care coverage by being on Sarah's policy. That allows him to defer enrolling in Part B until he comes off of Sarah's policy – with no penalties.
Jack will have no outpatient health insurance when he comes off of Sarah's policy. This means his best decision is to enroll in Part B. I advise Jack to contact his local Social Security office and make an appointment to enroll in Medicare Part B.
Once Jack receives his new Medicare ID card, which identifies he's enrolled in Medicare Part A and Part B, I'll then be able to sit with Jack and go over his options. I'll assist him in choosing a Medicare Plan that will suit his needs.
The Importance of Timeliness
Timeliness is of the utmost importance when applying for Medicare. Since Sarah Kellogg contacted me six months prior to her retirement, I was able to help Jack enroll in Medicare Part B with no penalties. I can now help him review his other Medicare options in order to find the one Medicare Plan that will fit him best.
The Kelloggs avoided a disastrous mistake that people often make when it comes to Medicare – that is the mistake of not contacting a Medicare Adviser early enough! If they had waited to contact me after Sarah came off her employer's health insurance policy, Jack would have had only eight months to complete his enrollment in Part B. In that amount of time you run into the risk of having paperwork lost, or dealing with delays in the Medicare system. Penalties would have been looming.
Sarah was concerned about Jack and took action by making preparations prior to her retirement. Sarah will purchase an individual short-term plan for herself until she reaches her eligibility for Medicare.
This was a good ending for the Kelloggs.
* * *
You're on Original Medicare! Congratulations! You're 65 years old and you have health insurance. But do you really understand what that means for you?
The simple explanation is that Medicare will pay the majority of your Medicare allowable bill. You'll pay the remainder of the bill. Medical care is not totally free of charge. It never was and it never will be.
Part A
Part A is the inpatient insurance of Medicare. This means when you're admitted to a hospital for medically necessary treatment, or you're admitted to a skilled nursing facility, or a Medicare-approved hospice facility, Part A of Medicare pays your medically necessary bill – after you've paid your deductible.
You don't have to pay a monthly or annual premium for Part A of Medicare as long as you contributed to payroll taxes for ten consecutive years, or paid into payroll taxes for forty quarters during your lifetime. Anyone whose spouse earned work credits will qualify for Medicare Part A also. Working all those years and paying into the separate hospital insurance fund, entitles you to Part A of Medicare at no additional premium.
Individuals who are ineligible for premium-free Part A coverage can enroll voluntarily by paying a monthly premium, if they also enroll in Part B. This is called Medicare Buy-In. You'll pay up to $407.00 per month. Penalties for late enrollment may apply.
Deductibles
Part A has deductibles. Each time you're admitted into the hospital for a medically necessary reason, and the number of admitted days is less than sixty consecutive days, you will pay a Part A deductible of over $1,000.00.
If you're admitted into the hospital, then released and you remain out of the hospital for at least sixty consecutive days, and then need to be admitted for a previous or new condition, you'll be billed a new deductible Part A charge.
First Things First
But let's take first things first. In 2015, you have a deductible over $1,000.00 if you are admitted to the hospital. You will pay the deductible for being admitted to the hospital as an inpatient every single time if each admission is sixty days apart. If you are admitted to the hospital less than sixty days apart, with the same diagnosis, you will not have to pay the deductible again. Medicare will pay the majority of your medically needed bill after you pay your deductible. You will not owe the remaining cost of the bill. Let's look at an example:
* * *
John is admitted into the hospital for chest pain. John spends three days in the hospital and has several tests. John has an echocardiogram, a catheterization test and an ultrasound of his heart. John is released from the hospital. Three weeks later, John receives a bill from the hospital for $33,000.00. John pays his current deductible of $1,216.00. That leaves a remaining bill of $31,784.00. Medicare will pay the pre-determined part of the bill. John will not receive an outstanding bill for any other medically necessary charges. If John is re-admitted to the hospital for the same condition in less than sixty days, he will not be charged another bill for medically necessary treatment as long as his hospital stay does not go over sixty days.
If John is admitted to the hospital for a new illness or injury within sixty days of his release from the hospital, he will pay his deductible all over again.
* * *
Confused yet? Let's try another example:
Poor John! Just three months later, he has a severe stroke and is admitted to the hospital again. This time, John has serious consequences due to the stroke and is admitted to the hospital for 63 days.
John will owe his Part A hospital deductible of $1,216.00. This is a new illness. The hospital bill is $150,000. After paying the Part A deductible, a balance remains of $148,784. Medicare will pay for the pre-determined part of the bill. John was admitted to the hospital for over 60 days. John will have to pay $315.00 a day for each day that he is admitted to the hospital over sixty days. John stayed 63 days. John will owe the hospital $945.00 for being an inpatient for days 61 through 63.
(Continues...)
Excerpted from The Medicare Survival Guide by Diane Daniels, Norma Jean Lutz. Copyright © 2015 Diane Daniels. Excerpted by permission of AuthorHouse.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Contents
Why I'm Passionate about Medicare, vii,Introduction, xv,
Chapter 1 The History of Medicare, 1,
Chapter 2 Do You Know Your A, B, C and Ds?, 8,
Chapter 3 Types of Medicare Plans, 47,
Chapter 4 Special Election Periods (SEP), 63,
Chapter 5 Turning 65, 69,
Chapter 6 End Stage Renal Disease (ESRD), 73,
Chapter 7 Veterans, 87,
Chapter 8 Medicare Transsexual Surgery, 95,
Conclusion, 99,
References Cited, 101,
About the Author, 103,