Good Morning Ms. Toni:
Have been reading your column for over a year and now I need some Medicare help. I am retiring and turning 65 in May. I had a triple bi-pass in September of last year. Last week I talked with the office manager at my cardiologist’s office about me getting on Medicare and what I should do. She said for me to enroll in “Traditional Medicare”. I have no idea what “Traditional Medicare” is? Could you please explain this and make it simple. I do not want to enroll in the wrong plan and totally mess up my Medicare. Thank You, Tommy a Katy Rancher reader.
I will make this as simple as I can. I have consulted with confused Texans who have a PHD in higher education and understanding Medicare just frustrates them. It can make a grown man want to “cry”! So let’s examine just what “Traditional Medicare” is and we will do this together.
Most healthcare professionals call Medicare, “Traditional” Medicare, but Medicare refers to it “Original” Medicare. You will not find “Traditional” Medicare anywhere on the medicare.gov website or in the Medicare & You handbook.
Original or Traditional Medicare consists of Parts A and B only, and not the rest of the alphabet soup, Parts C or D. Original/Traditional Medicare is also known as your Medicare card or as many on Medicare refer it to the “red, white and blue card”. There is not a network with “Original/Traditional” Medicare. If you doctor or healthcare provider accepts Original Medicare or Medicare assignment, then they will accept Traditional Medicare because they are the same thing.
Original/Traditional Medicare… Parts A and B are explained below:
MEDICARE PART A (In-patient Hospital Insurance) pays for your medical care while you have a hospital stay. Part A also pays some of the costs if you stay in a skilled nursing facility which has 100 day benefit, hospice, or if you receive home health care. The Part A deductible for 2013 is $1,184.00 and can be used 6 times or 6 deductibles in a year. Yes, Part A has a benefit period of 60 days, so every 60 days; there is a new deductible of $1184.00. If you go back in the hospital after a 60 day period, then you can have another deductible of $1,184.00. Skilled nursing has a $0 co pay for days 1-20, but from days 21-100, there is $148.00 co pay per day. After day 100, you pay all of the cost for each additional day. And yes they do bill you the additional cost.
MEDICARE PART B (Medical Insurance) helps cover for medically necessary services such as doctors’ services including doctor charges for surgery for inpatient hospital stay, outpatient hospital care/services, tests, home health care, durable medical equipment and other medical services. Part B has a monthly premium of $104.90 for 2012.**Note: Part B and Part D premiums are now based on income…not everyone pays the same amount. If you pay more than your friends for Parts B and D, it is because you make more money than your friend does.
Part B has a yearly deductible of $147.00. Once the $147.00 deductible has been met, then Medicare pays 80% of the Medicare approved amount and you or whoever is on Medicare, will pay 20% of the Medicare approved amount. A Medical provider may charge $1,000.00 for a service, but Medicare may approve $623.00, it is the $623.00 that the 20% is applied to.
Original/Traditional Medicare has some gaps and to fill the gaps is with a Medicare supplement that works directly with Original/Traditional Medicare, but has a premium.
Medicare did not place the 2013 deductibles and co pays for Parts A and B in the
2013 Medicare & You handbook. The rates were released in November, 2012 and can be found online at http://www.medicare.gov/cost.
Tommy, if you have any more questions contact me or email me and I will be glad to help you.
Toni King is an advocate/consultant for those “Confused about Medicare”. Email questions firstname.lastname@example.org or call 832/519-TONI (8664). Visit www.tonisays.com.