Hi, I am Matthew Claassen with
on Medicare to help you understand Medicare and your Medicare choices.
In the first video we talked about the initial enrollment period and how to enroll in Medicare.
In this video we're going to go over the pillars of Medicare
As we do so, I want to remind you not to lose sight of forest for the trees
Certainly we are going to talk about some deductibles and co-pays,
but don' get lost in the minutia. I want you to remember
to ask yourself; what it is that you want from your Health Insurance policy?
And, what you'll find into a later video
is that Medicare supplements that you can add to your Medicare policy
can eliminate virtually all of the Medicare co- pays and deductibles so that you have no out-of- pocket expense.
So don't get lost in it, so much is understand it for what it can do for you.
Medicare Part A is free to anyone who qualifies for Social Security income. Even if you delay your income, as long as you're qualified
you'll get your Medicare Part A for free. Medicare Part A is that portion that helps cover your inpatient hospital expenses.
Because Medicare Part A is free, most people will start Medicare Part A on the month that they turn 65 years old.
Your Medicare Part A coverage goes into affect the moment the you are admitted into the hospital has an inpatient.
Not in the hospital under observation, but as an actual inpatient.
This video is being produced in 2016, and as of 2016 there is a deductible for Medicare Part A of $1,260.
After that deductible Medicare pays 100% of your medical costs as an inpatient for the first 60 days.
It covers a semi-private room, general nursing care, 100% of your meals
and all of the drugs and other supplies that you receive while you're in a hospital.
Keep in mind that the average hospital stay is only three days. So, 60-days of 100% coverage is a lot of coverage.
Still, if you are in a hospital after 60 days, then you'll pay a $315 per day co-pay from days 61 to 90
and the $630 per day co-pay for days 91 to 150.
Medicare is not a long-term care policy. Your in- hospital coverage ends after 150- days.
if you're taking notes on the the deductible and the Koop a year
Keep in mind when we talk about Medicare supplements in a later video that as long as you have
supplement. That supplement will not only pay your deductible, but can provide you with coverage for a full 365 days
plus your original 60 days of 100% coverage.
Two important points about Medicare Part A; First is the $1260 deductible is not an annual deductible
it's a benefit period deductible. A benefit period ends when you have had 60 consecutive days outside of the hospital.
Here is an example; let's say you're in an automobile accident and your admitted into the hospital and you have a five-day stay.
They let you go, you go home and then two weeks or three weeks later either something related or unrelated happens and you are back
in the hospital again. Because you were not out of the hospital for 60 consecutive days that's considered the same benefit period.
When you go back into the hospital within the same benefit period, you don't have another deductible.
If you are out of the hospital then for 61-days, 62-days 63 or however long after 60-days and you go back in, you'll have another deductible.
The second thing you need to know is that
Physician services are actually covered under Part B. Physician Services are what the Dr. does while you are in the hospital
as an inpatient. For example if you have seen a Dr. for condition and you're admitted
into the hospital as an inpatient. The Dr. decides that you need a surgery.
If he is not an employee of the hospital, he simply works with the hospital and that's where he performs those surgeries.
and when you have the surgery
although the the room the anesthesiologist and all of the nursing aids will all be part of your
the doctor's fee himself for performing the Physicians Service
Will not be covered under
As a general rule of thumb, if you are an inpatient and the hospital and you have multiple services;
anything that is billed directly from the hospital is going to be covered under Medicare
If it's billed separately, it will probably be covered under
So, it is
Currently that premium is $121.80 a month.
It increases based on your income. If you have a more than $85,000 individual tax filing
(AGI) adjusted-gross-income or $170,000 jointly filed adjusted gross income
then you would pay more than that $121.80 per month for your premium.
If you or your spouse have credible health coverage from your employer then you can delay enrolling in
In fact, if you are getting credible coverage from your employer or your spouse's employer, you should getting your
It's not just because it'll save you the premium every month, but also because there are guarantees associated with
when you can enroll in a Medicare supplement or Medicare Advantage plan that are predicated on that date you start your Medicare Part B.
So, if you can delay it, you should. Keep in mind that insurance from the Affordable Health Care (Obama Care) or
COBRA are
As I had mentioned, in addition to the monthly premium
After you pay the annual deductible,
leaving you responsible for 20%.
covered or are actually covered on a timetable. For example, cholesterol tests are covered once every five years, others may be covered
once every year or every other year. When Medicare indicates that the services covered every year, every two-years or five-years;
they're not referring to calendar years. They are referring to 365-day periods. So if there is a service that says they will cover it once per year
there needs to be 365 -day period since the previous test for Medicare to still cover it.
Thankfully Medicare has a great free online tool to help you keep track of this. It will be the subject of another video
As you look at the services that Medicare covers, keep in mind one very important concept. Medicare will cover
those services that are medically necessary. Let me repeat that; Medicare will cover those services that are medically necessary.
It's a very important concept and one we will be bringing up later as we talk more about other Medicare choices.
In general, Medicare relies on your doctor's diagnosis to help determine what ever is medically necessary.
It may also be important to note that Medicare Part B is also what covers you for most of your cancer treatments and your chemotherapy.
Many people, when they first realize they have cancer and and they look for their drugs or treatment
to see if those drugs are covered under their prescription Plan D. When the find they aren't, they panic. When you have
drugs that are administered either through your doctor, at your doctor's office, those are covered by
pharmacy and pick it up and self adminsiter it.
service that you'll get for free. Whenever you have the wellness service
you do not pay a co-pay or deductibles. These are covered 100%. However you must let your doctor's office know that your visit is a
Medicare wellness visit when you make your appointment.
Then, once a year you get a new Medicare wellness visit. Again you must stress or
specifying to your Dr. when you make your appointment that it's a Medicare Wellness visit.
If you don't, then the odds are your Dr. will give you a physical not covered by Medicare.
Our next video is going to be on
If you find this information useful, then please LIKE this on YouTube, click the thumbs up button just below the video on the YouTube video
And Share this with your friends. If you find this information useful chances are others will too.
I am Matthew Claassen with