Tuesday, May 3, 2011

Medicare Made Simple

One of the most important yet also most perplexing elements of eldercare is handling health care insurance.

During last week’s Town Hall Forum, Todd Shetter, the COO of Health Care Group, helped Alzheimer's caregivers better understand options under Medicare and how they differ from Medi-Cal. Here is a summary of Medicare benefits Part A, B, C and D. Keep in mind premiums for each varies, depending on annual income.

Medicare Part A: Helps primarily with the cost of hospital stays and “medically necessary” skilled nursing services following a hospital stay. It’s important to note that A requires three admission days (three overnights that include midnight). It does not cover long-term custodial care; you need private insurance for that.

Medicare Part B: Helps with doctor’s visits and other medical services, such as ambulances, lab tests, supplies and outpatient surgery. It also can help provide in-home health services. It does not cover dental, vision, hearing or long-term care.

Medicare Part C: This plan combines A & B so that you are covered for hospital costs, doctor’s visits and other medical services. There is also optional prescription drug coverage. This plan operates as an HMO in that you are assigned select health care providers and requires you have A & B coverage. It also includes dental, vision and hearing exams.

Medicare Part D: Pays for your prescription drugs. You sign up for this benefit during the open enrollment period. If you are on expensive medications, it likely will be reflected in your premium.

Medi-Cal is called Medicaid everywhere except California. This program that helps pay medical costs for low-income residents, including the elderly, the disabled and those with high health care costs who’ve run out of money. It has eligibility requirements, and if you meet them, Medi-Cal will help pay for doctor visits, hospital stays, prescription drugs, rehabilitation, and other medical services.

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