facebook facebook facebook facebook

Insurance Basics and FAQ

Medicare Overview

Medicare is the nation's largest health insurance initiative.It was orginally signed into law on july 30,1965,by president Lyndon B Johnson,as an amendment to Social Security legislation.Individuals are eligible for medicare if:

they are a U.S. citizen or have been a permanent legal resident for 5 continuous years and they are 65 years or older. 

they have permanent kidney failure or need a kidney transplant.

they are eligible for Social Security Disability Insurance and have Lou Gehrig's disease.

Many beneficiaries qualify for both Medicare and Medicaid.In some states,for those making below a certain income Medicaid will pay Part B premium and for any drugs that are not covered by Part D.By 2031,enrollment in Medicare is expected to reach 77 million.

The Orginal Medicare program has two parts:

Part A (Hosipital Insurance) and Part B(Medical Insurance).
Medicare Part D provides comprehensive perscription drug coverage.Medicare Advantage plans are another way for beneficiaries to recieve their Part A,B and D benefits.

Medicare Part A (Hospital Insurance)

Part A covers hospital visits,including stays in a skilled nursing facility,if certain criteria are met:

The hospital stay must be at least three days,not counting the discharge date.

The nursing home stay must be for something diagnosed during the hospital stay.

If the patient is not recieving rehabilitation,but has some other ailment that requires skilled nursing supervision,the nursing home stay would be covered.

The care being rendered by the nursing home must be skilled.Part A does not pay for custodial,non-skilled,or long-term care.

The maximum length of stay that Part A will cover in a skilled nursing facility is 100 days per ailment.The first 20 days are paid in full by Medicare with the remaining 80 days requiring 
co-payment.If a beneficary used a portion of their Part A benefit and then goes at least 60 days without recieving facilty-based skilled services,the person qualifies for a new 100-day benefit period.

Medicare Part B (Medical Insurance)

Part B helps pay for some services and products not covered by Part A,generally on an outpatient basis.Part B is optional and may be deferred if the beneficiary or their spouce is still working.There is a lifetime peanalty of 10% per year imposed on the Part B premium if the beneficiary did not enroll when orginally eligible and does not have creditable coverage.

Part B coverage includes physician and nursing services,x-rays,laboratory test,influenza and pneumonia vaccinations,blood transfusions,and other outpatient medical; treatments administered in a doctors office.Medication administration is covered under Part B only if it is administered by the physican during an office visit.

Limited ambulance transportation,durable medical equipment including canes,walkers, wheelchairs,and mobility scooters.
Prosthetic devices such as artificial limbs and breast prosthesis
One pair of eyeglasses following cataract surgery
Oxygen for home use

Part A Deductible and Coinsurance Premium for 2016

Inpatient hospital,skilled nursing facility,and some home health care.
For each benefit period Medicare pays all covered costs except the Medicare Part A deductible during the first 60 days and coinsurance amounts for hosiptal stays that last beyond 60 days and no more than 150 days.

For each benefit period you will have a deductible of $1288,and you pay in 2016.

$0 per day for a hosiptal stay of 1-60 days.

A $322 per day co-pay for days 61-90 of a hospital stay

A $644 per day co-pay for days 91-150 of a hospital stay

all costs for each day beyond 150 days

coinsurance for skilled nursing is 

$0 for the first 20 days each benefit period.

$161.00 per day for days 21 through 100.

All costs for each day beyond 100 days.

Part B Deductible for 2016

$166.00 per year.

you pay 20% of the medicare-approved amount for services after you meet the deductible

Anthony Juels 805-616-914