Medicare 2014

As in years past, Medicare will be implementing changes to the program for 2014.  Below I compare the Medicare benefits in 2014 to the Medicare benefits from 2013.  Be aware that Medicare is neither associated with nor part of the Affordable Care Act (ACA, ObamaCare), and that these annual changes are in keeping with Medicare changes in the past.  Also be aware that the figures outlined below represent Medicare only: These numbers do not account for the Medicare Supplement or Medicare Advantage plans that most people have to supplement their Medicare coverage.

Part A                                                       2013                2014          

Hospitalization

Days 1-60 Co-Insurance                       $1,148.00         $1,216.00

Days 61-90 Daily Co-Pay                          296.00             304.00

Days 91-120 (One time only days)*          592.00             608.00

Skilled Nursing Care

Days 1-20                                                     100%              100%

Days 21-100 Daily Co-Pay**                     148.00             152.00

Days 101+                                        No Coverage    No Coverage

Part B                                                                                              

Annual Deductible                                    $147.00           $147.00

Physician Visits Co-Pay                                 20%                20%

Out Patient Labs                                           20%                20%

Out Patient Procedures                                  20%                20%

Medical Equipment                                        20%                20%

There are two types of plans to supplement Medicare; Medicare Advantage and Medicare Supplements.  Medicare Advantage plans are similar to HMO's and PPO's.  There are typically preferred and/or network providers who have contracted with the plan to provide services at an agreed price.  These plans are typically regional plans and often include co-pays and co-insurance payments from the patient.  While the Center for Medicare and Medicaid Services (CMS) requires these plans to be "actuarially equivalent" to Medicare, the variations are far too numerous to list here.  Before considering a Medicare Advantage plan, review the co-pays and co-insurance payments required.  Medicare Advantage plans are typically less expensive than Medicare Supplements.  

Medicare Supplement plans are accepted nation wide by any provider who accepts Medicare.  Though many companies offer Medicare Supplements, each plan is regulated by CMS, and each plan of the same type offers exactly the same coverage no matter what company issued the plan.  These plans tend to be a little more expensive but often times involve fewer or lower co-pays.  While Medicare Advantage plans do not require a medical review, Medicare Supplements often do. 

When first becoming eligible for Medicare parts A and B, it is important to understand your choices and options.  Some decisions can not be changed once you make your initial selection, so it is wise to employ the help of an Elder Care Consultant or a Licensed Insurance Agent in order to appropriately plan for your care both today and in the future.

* Medicare includes these days as a life time benefit.  When they are used once, they are no longer available and the patient is responsible for 100% of medical costs.  Many Medicare Advantage and Medicare Supplement plans provide up to 365 additional days of this benefit.

** Medicare pays 100% for days 1-20 provided the care is deemed to be medically necessary.  Medicare Advantage and Medicare Supplement plans may have different requirements to qualify medical necessity.  In my experience it is rare to see anyone receive 100 medically necessary days in a skilled nursing facility.  It is also important to remember that once care is no longer medically necessary and insurance is no longer paying for care, the patient is responsible for 100% of the nursing care costs.