Healthy Tips for Seniors: Traditional Medicare Explained to Assisted Living Houston Residents
What is Original Medicare, also called Traditional?
- It is the traditional fee-for-service program offered directly through the federal government. UnderOriginal Medicare, the government pays directly for the health care services you receive.
- "Original" covers 80% of medical expenses. Clients are responsible for the 20%.
- This includes Part A and Part B coverage if you enroll in both.
- There is also Part D (Drug coverage) and an optional supplemental insurance that pick up the 20% that original Medicare does not cover.
- Open Enrollment starts on October 15th to December 7th.
What does Part A covers?
- In general part A covers: Hospital Care, Skilled Nursing facility Care, Nursing home care (as long as custodial care isn’t the only care you need), Hospice, and Home Health Services.
- It also covers services like lab test surgeries and doctor visits. Supplies such as wheelchair and walker are as well covered when medically necessary to treat a disease or condition.
- There is no Part A premium (monthly fee).
What does Part B covers?
- Part B covers 2 types of services:
- Medically necessary services such as services or supplies that are needed to diagnose o treat your medical condition and that meet accepted standards of medical practice.
- Preventive services: Health care to prevent Illness or detect it at an early stage.
- Part B as well covers things like: Clinical research, ambulance services, Durable medical equipment (DME), mental health (Inpatient, Outpatient, and Partial hospitalization), getting a second opinion before surgery, and limited outpatient prescription drugs.
- According to the CMS website,Monthly Premium (fee) is based on your W2.
- There is approximately a $147 yearly deductible and the monthly premium (fee) is approximately $104.90 depending on your income.
Part D and Supplemental insurance (optional)
- Part D covers prescriptions. There are several plans available; you can choose one depending on the prescriptions you are currently taking. Monthly Premiums (fees) and deductibles vary depending on the plan you choose. Monthly premiums (fee) range from $15-$50. Yearly Deductibles may range from $300-$500.
- Supplemental insurance (Medigap). This type of supplemental insurance helps pay your out of pocket cost in Original Medicare. Depending on the type of supplemental insurance you choose there is a monthly Premium (fee). It may vary from $80-$250/month.
For more information on cost and plans please visit Medicare.gov in there you will find different plans that you may choose to fit your current needs.
For more Information regarding your insurance coverage/benefits please contact your insurance provider.
Karina Walker, RN DON @ 713-975-1519