Tag: Utah Medicare planning

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Medicare

What’s the Difference Between Medicare Parts A, B, C, and D?

What's the Difference Between Medicare Parts A, B, C, and D?

Medicare, the federally funded health insurance program, offers comprehensive coverage for individuals over 65, certain younger people with disabilities, and those with End-Stage Renal Disease. Understanding the different parts of Medicare is crucial for making informed healthcare decisions.

HERE’S A DEEPER DIVE INTO EACH PART:

MEDICARE PART A (HOSPITAL INSURANCE)

This fundamental part of Medicare covers services associated with hospital care, including semi-private rooms, meals, general nursing, and drugs as part of your inpatient treatment, and other hospital services and supplies. 

Examples include: stays in a hospital, skilled nursing facility, and sometimes nursing home care if the care provided is hospital-like. 

Importantly, hospice and limited home healthcare might also be covered if certain conditions are met. 

This coverage is typically premium-free if you or your spouse paid Medicare taxes for a certain amount of time.

MEDICARE PART B (MEDICAL INSURANCE)

Part B covers two types of services — medically necessary services and preventive services. 

It’s designed to cover certain doctors’ services, outpatient care, medical supplies, and preventive services. 

These include services like flu and hepatitis B shots, cardiovascular screenings, diabetes screenings, and various types of cancer screenings, which can help detect health issues early when treatment is most effective.

MEDICARE PART C (MEDICARE ADVANTAGE)

These are Medicare-approved plans from private insurers that bundle Medicare Part A, Part B, and usually Part D (prescription drug) coverage. 

Medicare Advantage Plans provide all of the benefits of Parts A and B, and often provide additional benefits such as vision, hearing, and dental care, and may include wellness programs. 

It’s important to compare these plans based on out-of-pocket costs and network restrictions to find one that best suits your healthcare needs.

MEDICARE PART D (PRESCRIPTION DRUG COVERAGE)

This part of Medicare helps cover the cost of prescription drugs and can help lower your drug expenses and protect against higher costs in the future. 

Part D plans are run by Medicare-approved private insurance companies. 

They vary in cost and drugs covered but must give at least a standard level of coverage set by Medicare.

Understanding each part can help you better manage your health care planning and utilization, potentially saving you from unexpected expenses and ensuring comprehensive coverage.

Navigating Medicare and understanding its various components is essential for maximizing your healthcare coverage and minimizing out-of-pocket expenses. 

Whether you’re newly eligible or looking to review your current coverage, Utah Senior Planning is equipped to guide you through each part of Medicare—ensuring you understand everything from hospital insurance in Part A to the additional benefits of Medicare Advantage and Part D prescription drug coverage. 

Don’t navigate this complex system alone; let our experts provide you with the personalized support and advice you need to make informed decisions about your healthcare. Reach out to Utah Senior Planning today, and secure your healthcare future with confidence.

Categories
Medicare

100 Days of Medicare Misconceptions

"Doesn't my loved one qualify for 100 paid days by Medicare in a nursing home?"

This is probably the most common question I get in my position.

The technical answer to this is yes, but the reality of this question is no. 

First off, it is important to ask which primary Medicare plan does the person have? 

  • Traditional Medicare (Government operated)
  • Medicare Replacement or Advantage Plan (Private Company operated) 

Traditional Medicare

Traditional Medicare will pay for 20 days of rehab at 100%. If the patient must stay longer for rehab, Medicare will continue to pay a portion and the patient must pay a large daily co-pay (2023 it is $200 per day). 

Medicare Advantage Plans

The Medicare Advantage plans like Humana or AARP have their own co-pay structure for rehab in a skilled nursing facility that is similar. 

So what is the big catch? 

One word, Rehab. 

In order to continue to qualify for rehab in a skilled nursing, the patient must continue to show progress and participle in rehab. If that progress slows (not getting better as fast as the insurance would like) or stops due to their health situation, both traditional Medicare and the private Medicare advantage plans will stop paying all together. 

On average, I see the private company plans stop paying after about 15-30 days and Traditional Medicare usually stops paying after 30-40 days. This is from my own experience, and may not be applicable to your situation. These are just averages from what I see. 

So the answer to the question, “Doesn’t my loved one qualify for 100 paid days by Medicare in a nursing home?”, is:

They could, but likely not, and even more likely not paid at 100%. 

⁃ Justin Embry