Medicaid planning is used to prepare for or deal with the end of Medicare benefits. The information provided
below will help you determine when or if your Medicare benefits will end and when you may need to look into the need for Medicaid
coverage to help pay for the high cost of long term care.
***Note: When a person is recieving
Medicaid benefits, they continue to be covered by Medicare - however, Medicaid becomes "secondary" health insurance.
Traditional
Medicare is the health insurance program administered by the federal government. It permits you to see any doctor
who will accept you as a patient. It provides hospital and medical insurance for:
People
65 years
Disabled individuals (24 consecutive months)
People with End-Stage
Renal Disease (ESRD)
Spouses of eligible workers, certain divorced persons, widows and widowers,
and dependents
Medicare consists of two parts:
Part A
- hospital insurance - helps pay for inpatient hospital, skilled nursing facility rehabilitation care and some home health
care.
Part B - medical insurance - covers physician services, outpatient hospital
care, durable medical equipment, ambulance service and lab tests.
Part A and Part B
have deductibles and coinsurance (see below)
Eligibility is automatic if you are collecting Social
Security retirement benefits. Part A is free if you have worked at least 10 years (40 quarters of Medicare-covered employment).
Part B has a monthly premium.
If you have not worked at least 10 years, you may be eligible
to buy Part A coverage: For people having 30-39 quarters of Medicare-covered employment the monthly premium is $254. For people
having less than 30 quarters the monthly premium is $461.
Part A - Medicare and patient
costs 2010
(Acute
hospital care; limited coverage for skilled nursing home, hospice and home care)
Days
Medicare Pays
Patient Pays
1 through 60
Everything after deductible is paid
Deductible of $1,100. **(was $1,068)
61 through 90
Everything after Co-Insurance is paid
Daily Co-Insurance of $275 per day**(was $267)
91 through 150 {life time reserve days - once per life-time}
Everything after Co-Insurance is paid
Daily Co-Insurance of $550 per day**(was $534)
151+
Nothing
All costs**
.
.
**Supplemental insurance can help cover costs
Part A - Skilled Nursing Home Rehabilitation 2010
(Ongoing coverage beyond the first 20 days
is subject to patient's ability to benefit from continued therapy and exhibit medical improvement. When patient becomes
a chronic care patient all Medicare coverage is discontinued)
Days
Medicare Pays
Patient Pays
1 through 20
Everything
Nothing
21 through 100
Everything after Co-Insurance is paid
Daily Co-Insurance of $137.50**(was $133.50)
101+
Nothing
All costs
.
.
**Supplemental insurance can help cover
.
.
.
Part B - Premiums / Deductible 2010
(Limited coverage for physicians, outpatient services,
diagnostic tests and durable medical equipment)
Deductible:
$155**(was $135.00) per year (Note: you pay 20% of the Medicare approved amounts for services after
you meet the $155.00 deductible)
Premium: $110.50 per month**(was $96.40) -if your income
is below $85,000/yr (Note: premium can be higher based upon annual income of household)
