Critter Corner: Is Original Medicare Sufficient?

Dear Angel,

My mom is eligible for Medicare this year and is exploring her options. She is not sure whether to get a supplemental plan, or if original Medicare is enough. What are your thoughts on this?

Thanks,
Iz Ittanuff

Dear Iz,

Most people on Medicare feel that original Medicare is not sufficient, and have some source of coverage that supplements Medicare.

Original Medicare has been around for over 50 years and is run by the federal government. Part A and Part B make up the core of original Medicare, and cover the following:

•Part A Deductibles and Copays: In 2018, if you are admitted as an inpatient to the hospital, you will pay a deductible of $1,340 per benefit period. This deductible covers your inpatient hospitalization for the first 60 days. For days 61-90 you would be responsible for a $335 per day. If you need to stay in the hospital for longer than 90 days you can tap into your “Lifetime Reserve Days.” These days can only be used once in your lifetime, and once they are gone, you cannot use them again. While you are using your Lifetime Reserve Days you would be responsible for a co-pay of $670 per day. If hospitalized longer than 150 days, you are responsible for all costs.

Medicare Part A covers short-term skilled nursing care and rehabilitation. This is when you need round the clock medical attention to recover from an illness or injury. Skilled nursing facility stays are covered 100 percent by Medicare for the first 20 days, provided that you have been admitted to the hospital, as an inpatient, for a minimum of 3 days (actually 3 midnights). Once you’ve stayed in a skilled nursing facility for more than 20 days, you are responsible for a copay of $167.50 for days 21-100. You pay all costs if you are in a skilled nursing facility over 100 days. Medicare does not cover long-term care or any type of nursing home costs beyond the 100-day period.

•Part B Deductibles and Copays: In 2018, the Part B annual deductible is $183 and most beneficiaries pay a monthly Part B premium of $134. You may have to pay more if your income is above a certain threshold. Once you meet your deductible, you will pay a co-pay of approximately 20 percent for most of your medical expenses. There are some preventive services that are free and not subject to the Part B deductible.

Part A and Part B are not enough

Part A and Part B cost-sharing can really add up, especially when you consider what Medicare doesn’t cover (including eye exams, hearing evaluations, dental care, routine foot care, and more). And, original Medicare has no cap on out-of-pocket spending. So, it’s definitely not enough for most seniors!

Make sure you do your homework and explore all your options when selecting the Medicare supplemental plan that is right for you. See Medicare.gov for details and helpful tips. And see today’s other article for important information about supplemental plans that are going away in the next couple of years.

Hope this is helpful,

Angel

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