Will it cover all your expenses?
And unfortunately, the answer to that is no.
So let's look at the details of Medicare A and B.
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get the most out of your Medicare benefits.
Now today's topic is actually a question about Medicare A and B.
We call it original Medicare A and B.
first off part A of Medicare is called hospitalization.
Insurance. It's pretty much everything that would be related to inpatient
care, either in the hospital or in a skilled nursing facility .
So our first responsibility when we're using Medicare Part A,
meaning we're in the hospital or in a skilled nursing facility,
we're responsible for a deductible of $1,556
and that's our full out of pocket for - notice up to a 60 day stay.
So it doesn't matter
whether I'm in the hospital one day or two or ten or 50 or 60 days,
anything between one to 60 days is the same out of pocket to me.
I have to meet my deductible.
$1,556 and that's this year of 2022.
Now this deductible is very unique to Medicare
because it's called a benefit period deductible.
And unless you're on Medicare, you've never had this
because our group plans at work or individual plans
have annual deductibles.
Well, this thing is not an annual deductible, it's a benefit period.
Here's the way that works.
Medicare defines the benefit period as you've been admitted to the hospital.
Let's say seven days later you go home, you're discharged from the date.
You're discharged for the next 60 days, you're still in your benefit period,
which means if anything happens to you during the 60 days of being discharged
where you have to go back to the hospital,
you're still covered by the same deductible
because you're in the same benefit period.
But let's suppose I'm admitted to hospital seven days later.
I go home, 60 days goes by
and nothing happens to me that would cause me to be hospitalized.
But after those 60 days, something happens after that.
And so now I have to go back to the hospital.
Then I would start a new benefit period.
I'd be responsible for another deductible
so that deductible can occur more than once in a calendar year.
All right.
So that is our full out-of-pocket for the first 60 days in the hospital,
which folks is going to cover probably 99% of every situation, but occasionally
there are people there in the hospital longer than 60 continuous days.
Number one, they're really sick, maybe even in a coma.
And so Medicare will provide 90 more days of coverage,
but they have daily co-pays that are going to range.
But the third month has a daily co-pay.
and month 4, and month 5 has a different daily co-pay.
So that's what you pay every day for the third month,
and that's what you pay every day for month 4, and month 5.
So these get very, very pricey and you're responsible for those.
All right.
So also, part A is going to cover skilled nursing facilities.
Now here's the rules.
Medicare says they will cover everything to the skilled nursing facility
for the first 20 days.
Now, just be reminded that this is after a stroke,
maybe after a hip replacement or some accident or a fall or an injury
where you need some fairly intensive rehab.
So Medicare says first 20 days, they'll pay it fully as long as you
were in the hospital a minimum of three full days.
They call it three midnight or 72 hours or longer in the hospital.
Then Medicare pays everything first 20.
Now, if you're not in three days or longer, they won't pay a penny.
But they'll pay everything as long as you've had the three day stay.
Now, if you happen to be in skilled
nursing more than 20 days notice, Medicare covers you for 80 more days.
But now you are responsible for a daily co-pay of $194.50.
They tell me right now the average Medicare recipient
is in a skilled nursing facility, somewhere between 30 to 35 days.
So the average person is spending two to $3,000 out of their pocket.
So those are the things that Medicare A will not cover.
Now let's look at the B side
of Medicare. B is called the outpatient side of Medicare.
And again, we have some gaps here.
We have some things that Medicare's not going to pay.
So the first thing they're not going to pay is the B deductible.
Now this B deductible is not like the A.
Remember, the a can happen more than once in a year.
The B is just once a calendar year and then it resets every January.
So if I start my Medicare July one,
this is my deductible on the B side of Medicare.
Remember everything
outpatient and doctors type services so that $233 would be my deductible
from July one to 12/31, and then it's going to reset again.
Sometimes it goes up a little bit, sometimes it stays the same.
But wherever it is beginning in January, you're responsible for the first $233
on the B side of Medicare after we've met that deductible.
Then Medicare is a very traditional 8020 plan.
Medicare is going to pay 80 and you're going to pay 20.
So as as long as you're seeing a Medicare provider
and you're getting a service that is medically necessary,
Medicare will pay 80% of that amount.
That's going to go to that doctor or to that surgeon or
or to that durable medical equipment,
all the services on B all those fees have been predetermined by Medicare
and of that predetermined fee, Medicare pays 80 and you pay 20.
All right, that's called co-insurance.
Now the problem with your 20%, it is totally unlimited.
Never, ever stop. Just keeps going and going and going.
So throughout the year, you're always responsible for whatever 20% of that B
bill would be all right.
And so you're responsible for that and it never stops.
Now people get insurance, as most do.
We can get that 20% covered by insurance.
But without insurance, you are going to be responsible for it.
And then lastly, you're going to pay all physician excess charges.
Folks, there are two types of doctors in the Medicare system there are docs
that take the Medicare approved amounts as payment in full.
They don't add to the bill.
That's about nine out of ten doctors, but one out of ten
doctors will not take that payment in full.
They're going to add to the bill and when they add to the bill
that is called an excess charge and the limit is 15%.
And when they add that to the bill, you're responsible to pay for that.
So Medicare allows them to build it,
but Medicare doesn't share in the cost of that.
You're fully responsible for excess charges.
And again, I'm not a huge risk right now.
But again, most people are on Medicare for 20, 25, 30 years,
and that could be a big situation, a big risk in the future
because those are the gaps that exist in Medicare, that Medicare
is not going to pay, that you're going to be financially responsible for those.
So frankly, most people that see all those gaps don't want to assume
all those gaps and transfer those gaps away to an insurance company.
They'll pay them.
A premium insurance company, in turn, will assume
the risk and the insurance company will pay out
Some of these gaps or all those gaps
based upon
the coverage that you buy, and of course,
you have to pay them a premium to take that risk from you.
So things that Medicare will not pay
that then you can take those risk and transfer those to an insurance company.
Hey, thanks so much for watching the video,
and I do hope that it was helpful.
Now if you feel like
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