The Medicare Maze

With Congressman Paul Ryan as Mitt Romney’s Vice Presidential running mate in the Presidential election, Medicare will be at the forefront of the political debate through Election Day in November.  Regardless of which party wins the November election, changes to traditional Medicare will be coming in the months and years ahead.  In order to assist our clients with Medicare and other health insurance issues, in January 2012, David Goldwasser joined our Elder & Disability Law Office as our health insurance specialist.

Medicare can be a wonderful benefit for those 65 and older. However, Medicare eligibility rules can be very complicated, and you may feel that you’re in a trap more complicated than running the gauntlet in medieval times. There are many factors which influence Medicare eligibility such whether or not you have medical coverage from a current employer, are covered by a spouse’s plan, or have retiree health coverage from a former employer.

So how can one best avoid these pitfalls? Careful planning, as with most things, is the answer. Medicare does provide a website which may help to answer some questions, but there are so many variables that it is really best to seek help from someone with expertise in the field, like an attorney or benefits specialist. In any case, here are some things to consider.

1) If you are already receiving Social Security, you will automatically be enrolled in Medicare Part A and Part B when you turn 65. If you aren’t yet receiving Social Security, you will have to apply for coverage, which can be done online. Part A, is hospital insurance, which is has no monthly fee, but does have certain expenses like a deductible of $1,156 for hospital stays of up to 60 days, copayments of $289 per day for days 61-90, and copayments of $578 per day for days 91-150 days.

2) Part B is medical insurance that pays doctors’ bills, lab tests and outpatient care. It is optional. The basic cost is $99.90 per month, although it can be as high as $319.70 if the individual is earning $214,000 or more a year. The annual deductible is $140 a year. Copayments are 20% of Medicare-approved amounts.

3) Part D covers prescription drugs. The basic cost is $32.34 per month, but those in high-income brackets pay more. Copayments and deductibles vary according to the plan that the individual has selected. But thanks to the Affordable Care Act, Part D’s “doughnut hole” is being phased out. But take note: THE ENROLLEMNT PERIOD FOR PARTS B AND D BEGINS 3 MONTHS BEFORE ONE TURNS 65 AND LASTS SEVEN MONTHS. If you miss the enrollment period, your coverage will be delayed, and your premiums will cost you more.

Now you can see why this is such a complicated matter. There are different conditions depending if your current employer has 20 or more employees, less than 20 employees, you have retiree health insurance from a former employer, or if you are self-employed and currently have noth insurance.

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