Most senior citizens have Medicare and supplement insurance to cover their medical needs. These two items cover most medical and hospitalization situations. Some might wonder what is Medicare and why do you need supplement insurance?
Medicare is a government run insurance plan for senior citizens. It has a Part A, Hospitalization, Part B, Medical, Part C, Advantage and Part D, Prescriptions. When you reach a certain age, at this time 65, and you paid into the Social Security System, you are eligible for Medicare. For a small premium you receive Hospitalization, Part A and Medical, Part B coverage and the limits are 80% and 20%. Which means Medicare pays 80% of the approved charges and you pay the remaining 20%. Approved charges are what Medicare deems acceptable for the services provided. Also the medical facility has to have a contract with Medicare. This can cause problems because the facility might have a Medicare contract but the treating physician does not, then you are responsible for 100% of the physicians fees.
For some medical and hospitalization that 20% co-payment amount can be quite large. In order to help with that co-payment some people purchase supplemental insurance. This covers the 20% co-payment that Medicare does not cover. Some of these supplemental policies might cover services that Medicare does not cover as well as prescriptions.
Basic Medicare does not cover prescriptions so you have to purchase Medicare Part D to cover your prescription expense. There are numerous plans and deductibles that have a wide variety of options. Some supplemental insurance plans do offer prescription coverage.
There are some Medicare plans, Part C, that cover 100% of the medical, hospitalization and offer prescription coverage. These plans also use your Medicare premium for the insurance coverage. These plans Medicare Advantage and the way they reduce costs is that they are usually an HMO, Health Maintenance Organization, or they limit what doctors and facilities you can use. For a higher premium you can opt for a different plan, such as a PPO, Preferred Provider Organization or indemnity plan and use the doctor or facility of your choice.
Medicare and Supplement Insurance has become a huge business and thousands of people have made careers out of trying to understand the rules of the game. It is a game because one day a service, procedure or item is approved and the next day it is not. It is a bureaucratic system that has special codes for billing and is usually a nightmare for the individual. As the health insurance system changes it seem trying to understand Medicare gets worse. Who knows what the future will bring.
With all this information what do you do? The good news is that if your parents have original Medicare and a supplement insurance or Medicare Advantage it does make the insurance process and financial burden a little easier. You should be able to take them to the doctor, medical facility or hospital and not have to worry about receiving huge bills. Depending on the billing department and the insurance handling the claims you might have to spend a lot of time on the phone trying to get certain billing matters corrected. Before you can do this you have to have your parent authorize you to talk on their behalf with Medicare and the insurance. Some companies have a form you can fill out and others have your parent do a phone interview that authorizes you to talk on their behalf. This is dictated by HIPAA, The Health Insurance Portability And Accountability Act.
If your parent only has original Medicare that only covers 80% of the approved charges you could be in store for some very large medical bills. There is no way to know how expensive medical care will be in the coming day, months or years. If you have money saved or assets you can sell, it might not be a problem but depending on your parents medical condition it might become one.
Thank you for your time and consideration.
Author-“You Got To Do What You Got To Do”
www.takingcareofaparent.comJames Colozzo is not a medical expert or professional and has no formal training or education on this subject. He is an average person that was given a challenge and had to deal with the situation. His experience comes from the over 20 years that he actually did all the work to care for his elderly parents and their medical conditions. Since every person, condition and situation is different, what Mr. Colozzo did to care for his parents might not be suitable for others. You need to partner with your physician to find what type of care is best for your situation.
Copyright © 2019 James Colozzo
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