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Medicare 101: Understanding the basics

by Tansy Quesada

Created on: September 01, 2008   Last Updated: September 09, 2008

"...Medicare has been a boon to the elderly and their children. Surveys show that beneficiaries are overwhelmingly satisfied with their care. Before Medicare, only 56 percent of the elderly had hospital insurance; the program has contributed to an increase in life expectancy and a sharp reduction in poverty among the elderly."

Quote from Robert Pear, Walt Bogdanich, Some Successful Models Ignored as Congress Works on Drug Bill, NY Times, p.1 (9/4/2003)

Medicare is a federal government managed healthcare plan offered to eligible seniors over 65 and a certain disabled segment of the population. Medicare can significantly help manage or lower your overall healthcare expenses. 95% of seniors, 65 years or older have Medicare coverage. Seniors over 65 year's old and disabled individuals that have Medicare coverage is 44.8 Million people in 2008 per the CMS data Compendium. Medicare is a wonderful help for the majority of American seniors and disabled individuals.

Medicare has different parts, such as Part A, which is hospital coverage. This is for the most part provided to seniors at no monthly premium cost because they or their spouse paid Medicare taxes while working. A deductible applies to hospital charges before Medicare will provide coverage. The current Part A deductible is $1024 per illness for 2008. This covers a percentage of hospital incurred expenses such as hospital stay charges, meals while in the hospital, some long term care facilities, hospice and home health care. For longer hospital stays there is a Part A copayment. The deductible covers the first 60 days of a Medicare-covered hospital stay. Then the recipient must pay $265 a day for days 61-90. After the 90th day, the co-pay for lifetime reserve days is $512 a day.

Part B is a Medicare supplemental plan in addition to the Part A. There is a monthly premium charge for Part B and this is usually deducted from your social security check. Part B provides coverage for Doctor's charges. This would include inpatient doctor's visits, office visits and some other services that Part A doesn't cover such as lab work, radiology, and some procedures and supplies. Some exclusions do apply. These can be determined by calling the Medicare hotline at 1-800-MEDICARE or online at www.medicare.gov. Part B is also subject to a deductible which is $135 for 2008 and then covers eligible charges at 80% in most cases.

Part C is coverage provided by Medicare through Advantage plans (similar to HMOs and PPOs), which are privately

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