Selected Podcast
What You Need to Know about Medicare for 2019
Medicare is federal health insurance for those over 65, individuals in terminal stages of certain health conditions, and young people with disabilities. Uganda Gaines, Corporate A/R Director, discusses what you need to know about Medicare for 2019.
Featuring:
Uganda Gaines
Uganda Gaines has 15+ years in medical billing experience with a specialty in Medicare billing. Over 10+ years of healthcare billing management experience. Healthcare billing experience ranges from LTAC Hospital, Acute care Hospital, FQHC & SNF billing. Transcription:
Bill Klaproth (Host): So what is Medicare and how does it work? You have questions? Chicago Methodist Senior Services has answers and here to talk about Medicare and what you need to know for 2019 is Uganda Gaines, Corporate Billing Director with Chicago Methodist Senior Services. Uganda, thank you for your time. So first off, what is Medicare?
Uganda Gaines (Guest): Hi, and thank you for having me. Okay, Medicare is Federal health insurance for people over 65 – 65 and older I should say or people who are younger that have disability or people with end stage renal disease or kidney failure.
Host: So what is the difference between Medicare and Medicaid? I just want to ask that right up front because I think there is some confusion about each of them.
Uganda: Okay, Medicare is funded through your Medicare and your social security that gets taken out of your paycheck as you work in your working years. Once you turn 65, that is how you get Medicare. So you’re automatically enrolled into Medicare part A after you turn 65 if you qualify and work a number of years. It’s usually about 10 years, it’s equal to 10 years. Medicaid is state funded insurance that is based on your income. So usually low income individuals can apply for Medicaid and then they have to meet certain income requirements and then they would be eligible.
Host: So you said when you turn 65, you’re automatically enrolled in Medicare is that right?
Uganda: That is correct, Medicare part A. So Medicare Part A would cover your inpatient hospital stays, your skilled nursing stays, hospice, and some home health.
Host: So do you have to go somewhere or go online to sign up? So you’re required at age 65 to sign up somewhere for this, is that right?
Uganda: You’re not signing up because if you’ve already paid in – they’ll send you a letter out. I think it comes the year that you’re going to turn 65 and they’ll let you know that you’re eligible – your Part A benefits will become effective as of the 1st of the month on the month you turn 65. So if you turn 65 on April 15th, you would become eligible for Part A on April 1st of that year that you turn 65.
Host: Okay, so you’re automatically enrolled in Part A, but then there’s also Parts B, C, and D. Can you explain those to us?
Uganda: Yes, so Part A is for your inpatient stays. So just like I said, if you’re admitted into the hospital, if you’re admitted into a skilled nursing facility or hospice facility or if you receive home health, they cover some of that. Part B covers your doctors’ offices. So more thank likely you’re going to use more of your Part B benefits than your Part A because you’re going to visiting your doctor’s office more than you would be admitted into the hospital. So that is something you would have to pay Part B premiums for. You’re not automatically signed up into Part B. Once you get Part A, you’re eligible for Part B but you can pay part B premiums that would come automatically out of your social security check. Just go online to Medicare.gov and you can sign up for that. Medicare Part D is your prescription coverage and that’s an additional premium that you can sign up for as well. Medicare Part C is a newer plan. What it is, is it’s an all-inclusive. So instead of having Part A, B and D, you would have one plan that covers all 3 of those, your inpatient, your outpatient, and your prescription coverage and you just have a private insurance. So instead of having Medicare pay your bills, you would have Blue Cross/Blue Shield or United Healthcare and you can choose. There’s several different plans and several different benefit coverages within those plans. You get to choose which one you’d like.
Host: Okay, so you can choose for what parts you want. Can you shop around? Where do you get these different parts from?
Uganda: Yes, so if you go onto medicare.gov or you can call 1-800-MEDICARE. They have a list of Medicare Part C plans that are in your area. So when you look at those Part C plans, you can choose the ones that benefits you. So if you’d like the ones with dental coverage or with vision coverage, there are some plans that would cover that and then all of them cover prescription. So like I said, it’s an all inclusive plan and instead of having A, B, and D you would just have just one plan, let’s just say Blue Cross/Blue Shield and then that would be your card that you would take to the doctor’s office and instead of your Medicare red, white, and blue card. They would send you out a card and you would take that to the doctor’s office.
Host: So if you’re over 65 and still choose to work and you get your healthcare insurance through your employer, how does all of that work in with Medicare then? Can you put it off until you – okay I’m going to retire at 70 and then I’m going to do Medicare or when you hit 65, no matter whether you’re working a full-time job and get your benefits – you’re signed up no matter what. How does all that work?
Uganda: That’s a good question. So with Medicare if you’re still working at you’re over 65, you can still have your Medicare benefits. They’re there for you because you’ve earned them but what you would have is insurance through your employer, which is an employer group health plan and then Medicare would then pay secondary to them. So your employer group health plan would be your primary insurance and then Medicare would pick up that secondary insurance if they have any copays or deductibles due, then that could be billed to your Medicare account.
Host: Okay, gotcha. So with Medicare coverage, can you tell us what it covers as far as skilled nursing and other things?
Uganda: Okay with skilled nursing, Medicare covers 100 days in the skilled nursing facility. The first 20 days are covered at 100% and days 21-100 are covered – everything is covered except for a per day coinsurance, which for 2019 is $170.50. So that means that on day 21, each day you stay in the skilled nursing, out of your pocket you would be paying $170.50 a day and Medicare would pick up the remaining balance and then you have 100 days, a total for a benefit period and what I mean by benefit period – once you get into the skilled nursing facility you have 100 days. If you stay out of the skilled nursing facility for 60 consecutive days, those days replenish. So you’re using your 100 days but let’s say you only use 50. If you stay out of the facility for 60 days and you have to come back into a skilled nursing facility, your days would start back at 100 and you get the first 20 days, 100% covered and the next 21-100 covered at everything except for the per day coinsurance.
Host: So after 100 days, the person is required to pay on their own?
Uganda: They would be out of pocket, private pay and if you have a secondary insurance sometimes people sign up for a secondary insurance or a Medicare supplemental insurance, sometimes they pick up or pay as primary after your benefits exhaust, but you would just have to look into that and also there’s long term care insurance that a lot of people get – well I shouldn’t say a lot of people but a lot of people don’t get it, but you can sign up for long term care insurance provided you’re not sick or I guess at a certain age it probably would be a higher premium but you can sign up for that which would cover a part of your inpatient stay in the skilled nursing.
Host: So if you have an inpatient stay and you have a surgery and then need skilled nursing after that, you have up to 100 days that will be covered by Medicare – I just want to make sure I’m hearing that correctly.
Uganda: That is correct, 100 days covered by Medicare and with regards to having the surgery, if you’re in the hospital you have to be in the hospital admitted for three consecutive midnights. So three days admitted in the hospital in order to have coverage for skilled nursing. That’s the requirement, the three consecutive inpatient hospital days proceed your skilled nursing stay.
Host: Okay, got it. So Uganda, is there anything else we should know about Medicare that we didn’t talk about?
Uganda: I think we covered Medicare Part A, Part B, Part C of course is also called Medicare Advantage Plan, there’s several and you just kind of have to shop around to see what works for you. Part D is the prescription coverage. You can choose – if you have a Medicare Advantage Plan, you can choose to come off of the Medicare Advantage Plan and go back to traditional Medicare or vice versa. After that, January 1st, your new plan would start and you would have, I believe it’s until March to change. If you got into a plan and you decided you didn’t really like it, you could switch back or shop around for something different. But Medicare like I said is covered for seniors 65 and older and younger people with disabilities or people with end stage renal disease.
Host: Great information Uganda. I appreciate your time today and once again for more information, you can visit medicare.gov. You can also visit cmsschicago.org, that’s cmsschicago.org. This is Living Well with Chicago Methodist Senior Services. I’m Bill Klaproth, thanks for listening.
Bill Klaproth (Host): So what is Medicare and how does it work? You have questions? Chicago Methodist Senior Services has answers and here to talk about Medicare and what you need to know for 2019 is Uganda Gaines, Corporate Billing Director with Chicago Methodist Senior Services. Uganda, thank you for your time. So first off, what is Medicare?
Uganda Gaines (Guest): Hi, and thank you for having me. Okay, Medicare is Federal health insurance for people over 65 – 65 and older I should say or people who are younger that have disability or people with end stage renal disease or kidney failure.
Host: So what is the difference between Medicare and Medicaid? I just want to ask that right up front because I think there is some confusion about each of them.
Uganda: Okay, Medicare is funded through your Medicare and your social security that gets taken out of your paycheck as you work in your working years. Once you turn 65, that is how you get Medicare. So you’re automatically enrolled into Medicare part A after you turn 65 if you qualify and work a number of years. It’s usually about 10 years, it’s equal to 10 years. Medicaid is state funded insurance that is based on your income. So usually low income individuals can apply for Medicaid and then they have to meet certain income requirements and then they would be eligible.
Host: So you said when you turn 65, you’re automatically enrolled in Medicare is that right?
Uganda: That is correct, Medicare part A. So Medicare Part A would cover your inpatient hospital stays, your skilled nursing stays, hospice, and some home health.
Host: So do you have to go somewhere or go online to sign up? So you’re required at age 65 to sign up somewhere for this, is that right?
Uganda: You’re not signing up because if you’ve already paid in – they’ll send you a letter out. I think it comes the year that you’re going to turn 65 and they’ll let you know that you’re eligible – your Part A benefits will become effective as of the 1st of the month on the month you turn 65. So if you turn 65 on April 15th, you would become eligible for Part A on April 1st of that year that you turn 65.
Host: Okay, so you’re automatically enrolled in Part A, but then there’s also Parts B, C, and D. Can you explain those to us?
Uganda: Yes, so Part A is for your inpatient stays. So just like I said, if you’re admitted into the hospital, if you’re admitted into a skilled nursing facility or hospice facility or if you receive home health, they cover some of that. Part B covers your doctors’ offices. So more thank likely you’re going to use more of your Part B benefits than your Part A because you’re going to visiting your doctor’s office more than you would be admitted into the hospital. So that is something you would have to pay Part B premiums for. You’re not automatically signed up into Part B. Once you get Part A, you’re eligible for Part B but you can pay part B premiums that would come automatically out of your social security check. Just go online to Medicare.gov and you can sign up for that. Medicare Part D is your prescription coverage and that’s an additional premium that you can sign up for as well. Medicare Part C is a newer plan. What it is, is it’s an all-inclusive. So instead of having Part A, B and D, you would have one plan that covers all 3 of those, your inpatient, your outpatient, and your prescription coverage and you just have a private insurance. So instead of having Medicare pay your bills, you would have Blue Cross/Blue Shield or United Healthcare and you can choose. There’s several different plans and several different benefit coverages within those plans. You get to choose which one you’d like.
Host: Okay, so you can choose for what parts you want. Can you shop around? Where do you get these different parts from?
Uganda: Yes, so if you go onto medicare.gov or you can call 1-800-MEDICARE. They have a list of Medicare Part C plans that are in your area. So when you look at those Part C plans, you can choose the ones that benefits you. So if you’d like the ones with dental coverage or with vision coverage, there are some plans that would cover that and then all of them cover prescription. So like I said, it’s an all inclusive plan and instead of having A, B, and D you would just have just one plan, let’s just say Blue Cross/Blue Shield and then that would be your card that you would take to the doctor’s office and instead of your Medicare red, white, and blue card. They would send you out a card and you would take that to the doctor’s office.
Host: So if you’re over 65 and still choose to work and you get your healthcare insurance through your employer, how does all of that work in with Medicare then? Can you put it off until you – okay I’m going to retire at 70 and then I’m going to do Medicare or when you hit 65, no matter whether you’re working a full-time job and get your benefits – you’re signed up no matter what. How does all that work?
Uganda: That’s a good question. So with Medicare if you’re still working at you’re over 65, you can still have your Medicare benefits. They’re there for you because you’ve earned them but what you would have is insurance through your employer, which is an employer group health plan and then Medicare would then pay secondary to them. So your employer group health plan would be your primary insurance and then Medicare would pick up that secondary insurance if they have any copays or deductibles due, then that could be billed to your Medicare account.
Host: Okay, gotcha. So with Medicare coverage, can you tell us what it covers as far as skilled nursing and other things?
Uganda: Okay with skilled nursing, Medicare covers 100 days in the skilled nursing facility. The first 20 days are covered at 100% and days 21-100 are covered – everything is covered except for a per day coinsurance, which for 2019 is $170.50. So that means that on day 21, each day you stay in the skilled nursing, out of your pocket you would be paying $170.50 a day and Medicare would pick up the remaining balance and then you have 100 days, a total for a benefit period and what I mean by benefit period – once you get into the skilled nursing facility you have 100 days. If you stay out of the skilled nursing facility for 60 consecutive days, those days replenish. So you’re using your 100 days but let’s say you only use 50. If you stay out of the facility for 60 days and you have to come back into a skilled nursing facility, your days would start back at 100 and you get the first 20 days, 100% covered and the next 21-100 covered at everything except for the per day coinsurance.
Host: So after 100 days, the person is required to pay on their own?
Uganda: They would be out of pocket, private pay and if you have a secondary insurance sometimes people sign up for a secondary insurance or a Medicare supplemental insurance, sometimes they pick up or pay as primary after your benefits exhaust, but you would just have to look into that and also there’s long term care insurance that a lot of people get – well I shouldn’t say a lot of people but a lot of people don’t get it, but you can sign up for long term care insurance provided you’re not sick or I guess at a certain age it probably would be a higher premium but you can sign up for that which would cover a part of your inpatient stay in the skilled nursing.
Host: So if you have an inpatient stay and you have a surgery and then need skilled nursing after that, you have up to 100 days that will be covered by Medicare – I just want to make sure I’m hearing that correctly.
Uganda: That is correct, 100 days covered by Medicare and with regards to having the surgery, if you’re in the hospital you have to be in the hospital admitted for three consecutive midnights. So three days admitted in the hospital in order to have coverage for skilled nursing. That’s the requirement, the three consecutive inpatient hospital days proceed your skilled nursing stay.
Host: Okay, got it. So Uganda, is there anything else we should know about Medicare that we didn’t talk about?
Uganda: I think we covered Medicare Part A, Part B, Part C of course is also called Medicare Advantage Plan, there’s several and you just kind of have to shop around to see what works for you. Part D is the prescription coverage. You can choose – if you have a Medicare Advantage Plan, you can choose to come off of the Medicare Advantage Plan and go back to traditional Medicare or vice versa. After that, January 1st, your new plan would start and you would have, I believe it’s until March to change. If you got into a plan and you decided you didn’t really like it, you could switch back or shop around for something different. But Medicare like I said is covered for seniors 65 and older and younger people with disabilities or people with end stage renal disease.
Host: Great information Uganda. I appreciate your time today and once again for more information, you can visit medicare.gov. You can also visit cmsschicago.org, that’s cmsschicago.org. This is Living Well with Chicago Methodist Senior Services. I’m Bill Klaproth, thanks for listening.