Let’s start at the very beginning….
By Margie Ware
In the musical “Sound of Music,” the famous song “Do-Re-Mi” starts off “Let’s start at the very beginning, a very good place to start…” Well, Medicare is sort of the same kind of proposition. In September we “begin school” with a review of what we forgot over the summer so we’ll be ready for new material this fall.
What is Medicare?
Medicare is the government sponsored health insurance program for those 65 and older who have worked under Social Security for 40 quarters or who have been disabled and on Social Security for two years. If you are under 65 and already receiving Social Security, Medicare will get in touch with you. If you do not yet collect Social Security, you must contact Medicare yourself beginning three months before your 65th birthday to sign up.
At the very least, by the time you are 65, you need to sign up for Medicare Part A. Our description of this part of Medicare is “your gift from a grateful nation” because you don’t pay for this benefit. You and your employer have been paying into this program through your payroll taxes during your working life.
What does Medicare Part A cover?
In general, Medicare Part A covers hospital stays (except for the first day, which is a deductible.) Part A also covers skilled nursing facility care, home health care and hospice care.
Most people also get Part B when they sign up for Medicare Part A. What does Part B cover? In general, Part B covers 80% of your charges for physicians’ services, therapy, diagnostic tests and ambulance services. It also covers durable medical equipment and items like lancets and test strips for diabetes patients. There is an initial deductible of $135 before the 80% coverage becomes effective.
If you need Part B and do not sign up for it, you can be penalized at a rate of 10% per year. Since the present Part B premium is $96.40 per month, these penalties can mount up quickly. Individuals with limited assets and income may not have to pay the Part B premium.
Some higher income retirees will pay more than $96.40.
Who doesn’t need Part B? If you are still working for a company with more than 20 employees and you are covered by employee health insurance, you do not need Part B. If you are also covering your spouse on that employee policy, she or he also does not need Part B. Once you stop being eligible for employee insurance, you and your spouse need to sign up for Part B. You always need Part B if you are on retiree insurance.
Medicare Part D is the program that covers prescription medication -watch this column, in the next two issues of “Berkshire Senior” when we cover this extensively. In preparation for that, please feel free to call the SHINE (Serving Health Information Needs of Elders) Program at Elder Services (1-800-544-5242 or 499-0524) and ask for a “Compare Plans” worksheet so you can send us your list of medications.
Medicare Part C is also known as Medicare Advantage. We do not have many Part C plans in Berkshire County. In other parts of Massachusetts, there are Medicare HMO’s, which combine the features of Medicare A and B and often include Medicare Part D coverage as well. In Berkshire County the only available Medicare called “Private Fee for Service.” Because these are new both to our area and to area providers, we urge anyone signing up for a Medicare Part C plan to contact the SHINE program for counseling prior to making a decision.
Where to get information
We encourage you to contact your local Council on Aging or Elder Services SHINE Program if you need to speak to a counselor about the details of the Medicare Program. And so, now that you’re reviewed your material, you’re ready for new challenges for 2010.
Margie Ware is Elder Services’ SHINE Coordinator.
