Medicare 101

Medicare is a health insurance program provided by the U.S. government for people over the age of 65, as well as others that meet specific criteria. With many different types and options, Medicare can be a complex, but essential, subject for many people. Medicare plays a significant role in providing financial security for health care services to over 60 million seniors.

Simply put, Medicare helps seniors to pay for healthcare and medical costs. It provides several options to help seniors meet the costs of doctor visits, hospital stays, and prescription medication.

Medicare offers many different products that cover specific services, such as:

• Hospital Insurance covered in Medicare Part A: Covers inpatient care in a hospital, long-term care over 25 days in a hospital, short-term nursing home care, skilled nursing facility care, home health care, and hospice care.
• Medical Insurance covered in Medicare Part B: Entails outpatient care, specific doctor's services, preventative services, and medical provisions.
• Coverage for prescription drugs in Medicare Part D: It caters to the cost of prescription drugs, including recommended vaccines and shots.
  

Levels of Coverage

With Medicare, patients have options regarding how they get their coverage. After enrolling, they need to decide how to get their Medicare coverage, usually through two primary ways: Original Medicare and Medicare Advantage.

Original Medicare includes Medicare Part A and Medicare Part B to help pay for services as they’re received. Original Medicare pays part of the cost for health care services and supplies. A deductible is applied at the start of each year. Once services are received, those enrolled in this fee-for-service health plan pay 20 percent co-insurance for all Medicare-approved services.

Also known as Medicare Part C, Medicare Advantage is a Medicare-approved plan that comes from a private company. Offering an alternative to Original Medicare for drug and health coverage, this plan includes Medicare Part A, B, and D and may provide some additional benefits not provided by Original Medicare.

Medicare at Spring Harbor

Due to the many levels of care offered to residents of Spring Harbor, Medicare is a requirement for anyone wishing to move into the community. However, it is important to note that because Medicare is considered healthcare coverage, it does not cover the costs of room and board at any independent retirement community. While it does not typically cover the cost of assisted living or long-term residential care, such as memory care, Medicare is required for all Spring Harbor residents as a type of safety net.

Covering long-term care services for short-term stays for specific conditions in skilled nursing care facilities, Medicare becomes essential in unforeseen scenarios. In the case that a resident needs a higher level of care, such as skilled nursing, Spring Harbor will assist in coordinating the appropriate Medicare benefits. For example, suppose a doctor determines that a patient needs specialized nursing after an inpatient hospital stay. In that case, Medicare may pay for part of the cost of a stay that does not exceed 100 days at a nursing facility certified by Medicare, including Spring Harbor.

How to Get Medicare

If you get benefits from Social Security at least four months before you hit 65 years, you automatically become eligible for Part A coverage, as well as Part B if you wish to keep it. For those that wish to wait to receive Social Security, you may opt to enroll directly.

Spring Harbor is here to help you navigate the various products offered by Medicare. As explained by Accounting Director Janet Peters, “If you have questions, we’re here to offer guidance. And if we don’t know the answer, we’ll find out for you.”

Contact Spring Harbor’s Accounting Department at (706) 576-6000 to learn more.