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MEDICARE Hospital and Post-Hospital Skilled Care Contrary to the belief of many seniors, one cannot rely on Medicare for payment of long-term care costs. Although Medicare is available to most individuals age 65 or older, coverage is limited to: qualified medical expenses (80% of an approved amount for doctors, surgical services, etc.); hospitalization for 90 days per benefit period with a deductible of $1,068.00 (total) for the first 60 days and a co-payment of $267.00 per day for the remaining 30 days, and an additional one-time, lifetime benefit of 60 days, with a co-payment of $535.00 per day (for a maximum of 150 days); and post-hospital skilled nursing home care with payment in full for 20 days and a co-payment of $133.50 per day for 80 days (maximum of 100 days). Gaps in Coverage Medicare only pays for nursing home care following a hospital stay of at least three days, and only if the care provided is considered “skilled care”. Skilled care is provided under the supervision of a doctor, requiring skilled professionals such as physical therapists or registered nurses, as opposed to “custodial care”, which provides basic personal care and other maintenance level services. Home health care may be available in limited amounts, but only if “medically necessary”, which is a very rigorous standard. For all Medicare benefits there are deductibles and co-payments, which can be substantial, and Medicare is in the process of becoming a “means tested” program. There are excellent insurance policies available to fill these “gaps” in Medicare coverage, appropriately called “Medigap” insurance, which must be purchased privately. Medicare does not cover hospital costs beyond 150 days, skilled nursing home costs beyond 100 days and, most importantly, Medicare does not cover any custodial nursing home care or non-skilled home health care. It is difficult for a Medicare recipient to qualify even for the limited “skilled care” benefits, and all others are considered “custodial” patients. With the Medicare Trust Fund currently projected to fail in approximately 2018, gaps in coverage are widening rapidly. Medicare Part D (Prescription Drug Coverage) Beginning in 2006, Medicare added a Part D program to cover the costs for prescription drugs. If you are offered prescription drug coverage through your employer as part of your retiree benefits, you may choose to accept this coverage or to enroll in Medicare Part D. All other individuals must select a Medicare Part D. Plan. The initial period for enrollment is the period that begins three months before and ends three months after the month of your 65th birthday (or the month you begin receiving Medicare based on disability). Individuals may only change their plan once a year, from November 15 through December 31. There are many different plans to choose from, and the choice is often confusing. The monthly premium for the Medicare Part D plan varies by company, and the basic plan costs approximately $30 per month, while the more comprehensive plans are more expensive. The basic plan deductible and co-payments are as follows:
If you are a low income Medicare recipient, the government offers “extra help” in meeting your premium, deductible and co-payment costs. There are a number of factors that you should take into account in deciding whether to enroll in a Medicare Part D plan and which plan to choose. Please contact Illinois estate-planning attorney Jay Kaufman for more detailed information on the new Medicare prescription drug benefit, or to schedule an appointment for a consultation. |
