Lincoln Resource Handbook:
Medicare

Medicare is a federal program that pays for certain medical expenses for people aged 65 and over. Those who are disabled or have End-Stage Renal Disease may qualify. Medicare is divided into four parts: Part A covers hospital bills. Part B covers doctors bills. Part C provides the option to choose from a number of health care plans. Part D provides the option to choose from a number of prescription drug plans.

With any questions or for information, contact the Medicare office: www.medicare.gov 1-800-MEDICARE (1-800-633-4227) 1-877-486-2048 (TTY/TDD)
or the Social Security Administration: www.ssa.gov 1-800-772-1213 1-800-325-0778 (TTY/TDD)
Medicare does not cover everything, nor does it always cover the full amount of covered items. For this reason it may be wise to purchase a Medicare Supplemental Insurance Policy (Medigap) or join an insurance plan (Medicare Select).

Medicare & You is a booklet that lists recent legislation changes and information on Medicare. Because it is necessary to stay current with recent changes, it is important to obtain a copy of the latest issue of this booklet. Medicare & You is revised each year.

In addition, there is the handbook titled A Guide To Health Insurance for People with Medicare. It is a guide for purchasing Medigap Insurance, using Medigap Insurance and understanding other kinds of health insurance available. It covers in detail what we will briefly outline here in this section.

Copies of either of these resources may be obtained by calling the Medicare office or found online at www.medicare.gov. Also visit www.medicare.gov/coverage to find out what services are covered by Medicare.

In this section, we will cover the basics of Medicare Parts A-D as well as some general things to look for in a Medigap or Medicare Select Plan.

Medicare 2007 Part A

Part A (Hospital Insurance) helps pay for care in hospitals and nursing facilities and for home health and hospice care. Part A is premium-free because of the Medicare taxes paid while you were working. Most who qualify are automatically enrolled at age 65

Medicare (Part A): Hospital Insurance-Covered Services Per Benefit Period⁽³⁾
Service	Benefit	Medicare Pays⁽²⁾	You Pay⁽²⁾
Hospital Stays Semi-private room, meals, general nursing and miscellaneous hospital services and supplies medically necessary.	First 60 days	All but $992	$992
	61 to 90 days	Anything Above	$248/day
	91 to 150 days ⁽¹⁾	Anything Above	$496/day
	Beyond 150 days	Nothing	All Cost
Post-Hospital Skilled Nursing Facility Care In a facility approved by Medicare, you must have been in a hospital for at least 3 days and enter the facility within 30 days after hospital discharge. ⁽⁴⁾	First 20 days	100% of approved	Nothing
	21 to 100 days	Anything Above	$124/day
	Beyond 100 days	Nothing	All Cost
Home Healthcare	Unlimited as long as you meet medicare conditions	100% of approved amount. 80% of approved durable medical equipment	Nothing for services. 20% of approved durable medical equipment
Hospice Care	Unlimited	All but $0-$5 copay for outpatient drugs and but 5% of inpatient respite care	$0-$5 copay for outpatient drugs and 5% of inpatient respite care
Blood	Unlimited	After first 3 pints⁽⁵⁾	First 3 pints
(1) Lifetime Reserve Days give you an extra 60 days when hospitalized for over 90 days. They may be used only once and are non-renewable. (2) These figures are for 2007 and are subject to change each year. (3) A benefit period begins on the first day you are admitted as an inpatient in a hospital or skilled nursing facility and ends after you have been out of the hospital or skilled nursing facility for 60 days in a row. There is no limit to the number of benefit periods. (4) Medicare and private insurance will not pay for most nursing home care. You pay for custodial care and most care in a nursing home. (5) Once the blood deductible is met, it is met for both Part A and Part B.

Nebraska's Part A Carriers (as of May 2007)

Coverage and claims for hospital and skilled nursing facilities:
Blue Cross and Blue Shield of Nebraska	877-869-6503
Mutual of Omaha Insurance Co.	866-580-5983
Coverage and claims for home health and hospice:
Blue Cross and Blue Shield of Alabama	205-988-2100

Medicare 2007 Part B

Part B (Medical Insurance) helps pay for doctors, outpatient hospital care and some medical services that Part A does not cover. Part B is voluntary and has a monthly premium ($93.50-$161.40/month in 2007). It is deductible from your Social Security, Railroad Retirement or Civil Service Retirement.

Medicare (Part B): Medical Insurance-Covered Services Per Calendar Year⁽³⁾
Service	Benefit	Medicare Pays⁽²⁾	You Pay⁽²⁾
Medical Expenses Physician's services, surgical services and supplies, physical occupational, and speech therapy, diagnostic tests, and durable medical equipment.	Unlimited if medically necessary	80% of approved amount after deductible. 50% for most outpatient mental health services	$131 deductible⁽⁶⁾ plus 20% of approved amount. Limited charges above approved amounts⁽⁷⁾
Clinical Laboratory Services Blood tests, urinalysis, etc.	Unlimited if medically necessary	100% after deductible	$131 deductible⁽⁶⁾
Home Healthcare (If you don't have Part A) Intermittent skilled care, home health aide services, durable medical equipment	Visits limited to medical necessity	100% of approved amount. 80% of approved amount for durable medical equipment after deductible	$131 deductible⁽⁶⁾. Nothing for services. 20% of approved amount for durable medical equipment
Outpatient Hospital Services	Unlimited if medically necessary	80% of approved amount after deductible	$131 deductible⁽⁶⁾. A coinsurance or copayment amount which may vary by service
Blood As an outpatient or as part of a Part B covered service.	Unlimited	80% of approved amount after deductible and starting with 4th pint	First 3 pints⁽⁵⁾ plus 20% of approved amount after $131 deductible.⁽⁶⁾
(2) These figures are for 2007 and are subject to change each year. (3) A benefit period begins on the first day you are admitted as an inpatient in a hospital or skilled nursing facility and ends after you have been out of the hospital or skilled nursing facility for 60 days in a row. There is no limit to the number of benefit periods. (5) Once the blood deductible is met, it is met for both Part A and Part B. (6) Once you have had $131 expenses for covered services, the Part B deductible does not apply to any further services you receive the rest of the year. (7) You pay for charges higher than the amount approved by Medicare unless the doctor or supplier agrees to accept Medicare's approved amount as the total charge for services rendered.

Nebraska's Part B Carriers (as of May 2007)

Coverage and claims for physicians and medical services:
Blue Cross and Blue Shield of Kansas	785-291-4038
Coverage and claims for durable medical equipment:
Blue Cross and Blue Shield of Alabama	205-988-2100

Medicare Part C

Medicare Part C, formerly known as Medicare+Choice, is now known as Medicare Advantage. Medicare Advantage is a plan obtained through a private health insurance company that offers expanded benefits depending on the type of policy purchased.

To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You pay the Medicare Part B premium and possibly an additional premium for the added benefits offered in the Medicare Advantage Plan.

Medicare Part D

Medicare Part D is a voluntary prescription drug benefit that offers prescription drug insurance and some other health coverage for those eligible. They are stand-alone drug plans offered by insurance and other private companies.

Those enrolled in Medicare Part A or Part B are eligible for a Medicare Part D Prescription Drug Plan (PDP) that offers only prescription drug coverage. Those enrolled in a Medicare Advantage Plan (Part C) are eligible for a Medicare Advantage Prescription Drug Plan (MA-PD) that offers both prescription drug and other health coverage.

There are many different PDP and MA-PD options to choose from in Nebraska. Things to consider when deciding on a prescription drug plan that best benefits you include:

Drugs covered by that plan
Available pharmacies with that plan
Annual deductibles
Monthly premiums
Monthly cost share
Possible future needs

Comparisons of prescription drug plans can be found on the Medicare website at www.medicare.gov. You can determine availability and cost of your prescriptions by conducting either a personalized plan search or a generalized plan search.

If you are turning 65, you may enroll in a Medicare drug plan from 3 months prior to your birth month until 3 months after your birth month. If you are over 65 and you have drug coverage, you have 63 days from the last day of your coverage to enroll. If you already have a Medicare drug plan and wish to change it, you may do so between November 15th and December 31st each year for coverage beginning January 1st of the following year. For those who choose not to enroll originally when eligible, a late penalty fee of 1% of the premium per month not enrolled may be assessed.

If you have limited income or resources, you may qualify for extra help paying your drug costs.

Medicare Supplemental Insurance

You may purchase one of twelve standard Supplemental Insurance Policies (Medigap or Medicare Select) for extra benefits. Some policies help pay Medicare's co-insurance amounts and deductibles.

Medigap is a Medicare supplemental insurance policy that is sold by a private insurance company to fill the gaps in the Medicare Original Part A and Part B Plan coverage. There are twelve standardized policies, labeled Plan A through Plan L, and they only work with the original Medicare Plan. Purchasing a Medigap plan allows you to go to any doctor or hospital that accepts Medicare.

Medicare Select is a type of policy that must meet all the requirements that apply to a Medigap policy AND may require you to use doctors and hospitals within the carrier's network in order for you to be eligible for full benefits.

For more information on Medicare Supplemental Insurance Policies, obtain a copy of the most recent Guide to Health Insurance for People with Medicare at:

www.medicare.gov
1-800-Medicare (1-800-633-4227)
1-877-486-2048 (TTY/TDD)

Care Consultants for the Aging does not recommend or endorse any of the services or facilities that are named or advertised in the Handbook. As always, we encourage you to investigate any product or service that is being considered.

Although every effort has been made to assure the accuracy of this information, we apologize in advance for any services, products, or organizations that may have been omitted or any errors noted within. We welcome corrections and additions. Please e-mail us at ccainc1@yahoo.com or call us at 402-398-1848 with any suggestions. Thanks!