By Kimberly A. Paton, Esq.

Medicare is a great Medical Insurance Program that becomes available to “Tax payers” when they turn 65. Not 65 yet? You should begin your Medicare application three months prior to your 65th birthday. Do not wait for “Full Retirement Age”, that is for Social Security.

Medicare is complicated and has many parts. How do you know which part(s) are right for you? We’ll break them down.

What is Medicare? Medicare (not to be confused with Medicaid) is an entitlement program for Medical Insurance. You paid for this while working. It has multiple parts:

                        Part A: covers hospital costs. Everyone receives this automatically if they qualify for Medicare.\

                        Part B: covers doctors. You must opt for this and pay extra. The cost can be deducted from your      Social Security payment, if applicable.

                        Part C: is the Advantage Programs which are offered by private insurance companies and frequently covers doctors, hospitals, rehab, dental, vision, and hearing. Typically it has lower costs, however, there are more restrictions. Think of it like an HMO. These are typically better for people who are healthy. Once you have a serious illness you are probably better off on Parts A and B with a “Supplement”.

                        Part D: is a prescription plan offered by private companies and covers medications. These can be difficult because different plans cover different medications and can change coverage.

                        Hospice: was designed to keep people comfortable at home at the end of their life. It offers approximately 1-2 hours of care in the home (or facility), to aid, feed, or provide companionship to someone. Note: only the cost of the aide is covered, not room and board. (Again, don’t confuse this with Medicaid)

What Supplement options are available?  Medicare Supplement (or Medigap) coverage is an additional private insurance that covers the deductibles and co-pays of Medicare. This is especially important if you need rehab after an illness because Part A will cover the rehab if you are in the hospital for 3 midnights and rehab is needed to improve your condition for up to 100 days, but it only covers 20 days at 100%.

After that, there is potentially coverage for another 80 days if you are improving and trying; but there is a co-pay of about $160 per day. This is when the Supplemental insurance is necessary to cover this $160 since regular insurance (through your employer) probably will not cover it.

Note that the hospital stay is very important, or Medicare will not cover rehab expenses, and then the Supplement will not cover anything. Oftentimes now, hospitals do not “admit” a patient. Instead, the hospital keeps the patient for “observation,” which does not satisfy the hospital requirement. The admissions office should explain this, but always ask. Note that this requirement has been modified due to COVID-19.

A person can have both Medicaid and Medicare because they cover different expenses. Medicare covers medical expenses; Medicaid is used for long-term care/facilities and in-home caregivers.

We, at The Paton Law Firm, can help you through this maze.