by John Leslie of Physicians Mutual Insurance

 

Many of you are years away from Medicare, but some are just around the corner.  Here are some important things you need to know about Medicare and Supplemental Insurance.

Part A is automatic coverage and covers hospital stays and has no premium attached.  It has a $1,340 deductible for a hospital stay and is due each time you are admitted, up to 6 times per year.  This plan also covers skilled nursing (rehab) facilities after a minimum of 3 days in the hospital and will pay 100% for up to 120 days.

Part B covers doctors, surgeons, blood (after the first 3 pints)and durable medical equipment and does have a premium involved.  If your total income (including retirement income, investments, etc.) is less than $85K, your premium would be $134 per month.  It pays 80% and you cover 20%.  Part B also pays for an ambulance if you are NOT ambulatory.  So if you walk to the stretcher or get on it yourself, they will not pay for the ambulance.

Part C is the Advantage Plan and is private insurance (HMO/PPO) that you pay a premium for and is regulated to receive treatment in the county in which you live.  It is not longer Medicare, but privatized.  John does not recommend this plan because if you get treatment in a nearby county you are out of network.  Medical providers do not like the Advantage Plan in general and they account for 50% of the market. 

Part D is a drug plan and you are required to get it or pay a penalty.

Supplemental Plans allow you to go anywhere and pick up what is not covered by Plans A&B. 

 

Recommendations:

If you have a long term care policy through your employer and have the ability to keep it, you should because it is harder to get once you have already retired.  Long term care costs an average of $68K per year and many companies have stopped writing it because people are living longer.

 

RSVP to Karlon Cox:

karlon.cox@prosperitybankusa.com

Cell: 940-366-2747