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2010 Medicare Fact Sheet

It is always advisable to obtain up to the minute advice when you have Medicare coverage questions. Our care managers can help you find the answers to your situation!

Part A: “Hospital Insurance”, covers inpatient hospital, certain skilled nursing and skilled home health services. It does not cover long term or custodial care.

Part B: “Outpatient Services”, covers Medicare eligible physician’s services, outpatient hospital services, certain home health services or therapies, and durable medical equipment.

Part D: “Prescription Drug Coverage”, offered through stand alone plans via private insurers or as part of a Medicare Advantage Plan.

Medicare Advantage Plan (AKA Part C): Health Plans such as PPOs and HMOs that are approved by Medicare and run by private companies. They may include additional benefits not covered by regular Medicare and may require you to use networks of providers and follow other restrictions.

Medigap Plan (AKA Supplemental Policy): These policies help pay some of the costs not covered by regular Medicare (such as co-pays/deductibles).

2010 Medicare #s:

Medicare A Premium:

$0 if you or spouse has 40+ quarters of Medicare-covered employment $254 with 30-39 quarters of Medicare-covered employment $461 with 29 or less quarters of eligible employment

Medicare B Premium:

Income of $85,000 or less ($170,000 for joint filers): $96.40 if you currently have premium withdrawn by Social Security $110.50 for new beneficiaries or anyone not having premium withdrawn by SSA Income higher than $85,000 ($170,000 joint): scaled higher up to $353.60

Medicare A Co-Insurance:

$1100 deductible/$0 coinsurance for days 1-60 $275/day for days 61-90 $550/day for up to 60 additional "lifetime reserve" days after 90 days All costs beyond 150 days, or once lifetime reserve days used past 90 Days.

Medicare B Deductible:


Medicare A Skilled Nursing Care:

pays 100% up to 20 days $137.50/day co-pay for patient for days 21-100.

This information provided by The Care Management Team, a comprehensive care management company offering medical advocacy and care management services. We are available to help with insurance, bill paying, and benefit issues. We can assist with Medicare and Medicaid questions, insurance claims, help apply for benefits, choose facilities, make appeals, and with many related concerns.

Reference: or 1-800-MEDICARE

Initial eligibility: When you first become eligible for Medicare (age 65 or typically, 24 months after receiving Social Security Disability) your initial open enrollment for Parts B and D is a 7 month window (including the 3 months before and after month of eligibility). If you receive SS benefits, you will automatically receive a Medicare card and be signed up for Part B (follow instructions on your card if you wish to reject Part B). Part D requires active sign up. If you are covered by an employer or other plan, your benefits coordinator can provide information on how it works with Medicare. You should confirm the plan is “creditable” (the same or better than what Medicare offers) and save the letter of creditable coverage. If later, this coverage ends through no fault of the individual, you can enroll without penalty. During the first 6 months of Medicare eligibility you are also guaranteed issue for a Medigap/Supplemental policy.

Penalties: The penalty for not enrolling in a Part D plan is 1% of the national base premium multiplied by the number of months you did not enroll and were eligible (and went without creditable coverage for 63 continuous days or more), rounded to the nearest 10 cents. This amount is added to your monthly premium every month as long as you are enrolled. In most cases the only chance to enroll or switch plans after initial eligibility for Part D is the annual election period (11/15-12/31). Exceptions include moving out of a plan’s coverage area, losing creditable coverage, or being misled or not fully covered by a plan (or if a plan stops coverage). Late enrollment for Part B carries a 10%/year penalty and you can enroll annually from 1/1-3/31.

Plan Costs: Many Part D plans have what is known as a “donut hole” or coverage gap, meaning that once you received a certain amount of coverage each year, you pay all out of pocket costs until you reach “catastrophic coverage”. There are a number of plans that offer gap coverage, although it may only be for specified drugs. This, along with the varying premiums and co-pays for medications, dictates the importance of comparing plans individually and estimating which plan best fits your circumstances.

Medicaid/Financial Assistance: People who are “Dual Eligibles”, eligible for both Medicaid and Medicare, will be automatically enrolled by Medicare into a Part D plan, but can chose another plan if they would like (from amongst certain “low cost” plans). Individuals will have co-pays on their medications through Part D, unless they are “institutionalized”, i.e. in a nursing home. There are several different types of Medicaid programs available with varying levels of benefits, as well as additional help through Social Security for those with limited income and assets.

Analyzing Plans: Medicare offers a plan compare tool online. To use this tool, the individual should have available their Medicare #, effective date for Medicare (both are found on the Medicare card), last name, date of birth, and zip code, as well as a list of all medications including dosages and frequency. In addition to showing cost projections for the plan, you can review the plan’s performance and see details regarding customer service.

Medicare Advantage: The Medicare Advantage Plans (AKA Part C) are privately run plans approved by Medicare, and generally combine a number of the different benefits into one plan. These include HMOs, PPOs, and Fee for Service plans. They are often able to include extra benefits such as health club memberships or vision/dental coverage. These plans may be appropriate for certain individuals, especially those looking for extra benefits at lower cost. However, many individuals who sign up do not realize the potential restrictions. The HMO and PPO plans have networks of providers, meaning the potential doctors, specialists, and rehab./nursing facility choices may be limited. The Fee for Service plans do not have networks per se and are thus marketed as having full choice, but not all providers participate due to the negotiated fees and thus in reality, choices may be limited. Typically, you get your medication coverage through the Advantage plan and won’t be able to use a Medigap plan for costs while enrolled in Medicare Advantage (however, be aware if you drop a Medigap plan you will likely not be able to repurchase and will not be guaranteed issue). Clients should review all options carefully and weigh the pros and cons of each plan. If clients find themselves in a plan they do not like, there are options for disenrolling and returning to regular Medicare coverage.

It is also wise to reevaluate your Part D choices each year during open enrollment, as the plans make modifications, more options become available, and your health status changes. Review your “Medicare and You” handbook for information on all of the Medicare programs, rules, resource #s and procedures.

Medicare generally does not cover: long term care, routine dental care, dentures, cosmetic surgery, hearing aids (some Medicare Advantage plans add extra benefits such as dental or vision).

IDAHO MEDICAID - Planning for eligibility

Medicaid is a public benefits program that many seniors access in order to help pay for the exhorbitant costs of long-term care. But misperceptions and fears regarding Medicaid abound. Let the information that follows serve as the start of your education about Medicaid planning and how this program can help meet the needs of your family while learning how to protect all of the assets you are legally entitled to protect.

Education is crucial when dealing with expensive long-term care costs.

By understanding your options, you can protect assets and obtain Medicaid benefits that can stop the drain on your resources that long-term care causes.

It is an unfortunate fact that most people spend more money on their long-term care costs than they are legally obligated to spend – this simply comes from a lack of knowledge about the applicable rules and regulations that govern this public benefits program.

elder with walker Idaho medicaid

If you or someone you love needs help because of their age or health situation, you can get help to navigate the long-term care maze, qualify for Medicaid benefits to stop the drain on your finances that expensive long-term care causes, and protect everything you are legally entitled to protect. As in all the issues surrounding long-term, chronic illnesses, it is crucial that informed decisions be made. Timing with regard to Medicaid eligibility and estate recovery (explained below) is vital in order to attain the dual goal of speeding up Medicaid eligibility while protecting assets. The primary question seniors and their families face: How do I afford to pay for the care that I need while protecting assets for my spouse (or other family members) without having all of my hard earned savings consumed by expensive long-term care costs?

Knowledge of how to qualify for Medicaid benefits often plays a central role in answering the question about how to pay for quality long-term care.

Remember, the days of residents in long-term care facilities whose care was paid by Medicaid being relegated to a separate wing and receiving a different (lower) level of care are long gone. Federal law prohibits facilities from discriminating against residents based on the source of their payment.

What Is Medicaid Planning?

medicaid planning

Medicaid planning is a process of applying the law governing Medicaid eligibility and estate recovery to your particular financial and health care situation. As a primer on this complicated area of the law, see The Consumer’s Guide To Medicaid Planning

Medicaid laws and Idaho Department of Health and Welfare policies and practices (often unwritten) that are crucial in this area of planning are constantly changing. Make sure to obtain the assistance of a trusted professional and certified elder law attorney who focuses on this niche area of the law. Any planning that you have done should be customized to fit your family’s specific needs and desires. That planning should include all necessary legal documents, consultations and other services, including insulating you from having to deal with the government directly. Speak to someone who can advise you about how to qualify for Medicaid benefits, put in place the legal documents necessary for qualification, but also handle the entire application process for our clients and their families.