Medicare Part A
Buyer Beware:
Benefit Triggers Often when can't do 2-3 Bathing (be sure this is included) Toileting Eating Dressing Walking
Facts on Long-Term Care
By 2020 12 million older adults will need Long term care Family/friends are caregivers for 70% of elders People age 65 have a 40% lifetime risk of entering a nursing home 10% will stay there 5 years or longer 22% of > age 85 are in a nursing home One year in a nursing home averages > $50,000
Example of Drug Plan
CIGNA Medicare Rx Plan Three Monthly premium = 32.90 Annual deductible = $325 Amount for prescription = $2-$68 co-pay
Long Term Care Insurance
Certain physical and/or mental impairments trigger benefits. Generally R/T inability to perform certain ADLs, Typically, benefits are payable when you're unable to perform a certain number of ADLs (e.g., two or three).
Medicare Part B: 2016 What does it cover what is the premium? deductible? annually charges %
Helps cover MD services and outpatient care Monthly premium = $104.90 Deductible = $147 annually (+ 20% of Medicare-approved amount for services after deductible) Person pays premium based on income
Medicare Part A
Helps cover inpatient care in hospitals Most people don't pay for it Starts 1st day of the month you turn age 65
Costs of Long Term Care Insurance
Based on how much coverage a person wants Benefit period (# of years) Maximum lifetime benefit Example: Person age 65 pays approximately $2500/year with $150/day benefit for 4 years
Buyer beware:
Alzheimer's Disease (may be physically capable, but not cognitively) Coverage Exclusions? Pre-existing conditions? Drug/alcohol abuse Mental disorders Self-inflicted injuries Alzheimers Heart disease Diabetes Cancer
Medicare B Helps Cover Is long term care and medications covered?
Ambulance (if medically necessary) Diabetic Supplies (not syringes/insulin) Foot exams (if are diabetic) Kidney Long-term care is NOT covered Medications are NOT covered Blood transfusions
Medicare Part A: Approximate Costs Hospital Stays
Approximate Costs Hospital Stays
Part D: Approximate Costs
Deductible = $310 After deductible is met, beneficiary pays 25% of costs Initial costs must reach $3310 in 2016 The Donut hole -beneficiary pays 45% of price of generic drugs (in 2015) Then pays lesser amount for drugs after has paid $4700 Premium depends on plan (often less than $40/month)
Medicare Group B Covers What does it cover
Diagnostic Tests Covers 2nd opinion for surgery Outpatient medical/surgical services Durable medical equipment (walker) Blood tests Preventative Services (FOB, Pap , PSA)
Buyer Beware:
Die without using benefits? Rate increases? May be up to 20%
Why is Part D confusing?
Not all drugs are covered by all plans
Example of Plan: Easy Choice Plus Plan
Premium: 28.80/month Deductible: $320 Co-Pay: 25% of costs 'Out of Pocket Limit: $6700
Drug Benefits
Prescription drug plan Medicare Part D Generally will pay a monthly premium Not all drugs are covered by all plans
PSA
Prostate specific antigen
Skilled Nursing Facility Care 20 days 21-100 101- beyond
Pt. pays $0 for first 20 days Pt. pays $157.50 for days 21-100 Days 101 and beyond: all costs
Hospital Stays: Semi private room: price Days 1-60, 60-90, 91+
Semi Private room, $1260 deductible each benefit period Days 1 to 60: $0 co insurance Days 61-90: $315 per day Days 91+: $630/day
