March 2015 | Omaha Insurance Solutions

Know Your Medicare Costs and Coverage Limitations

If you are dirt poor, you may have nothing to worry about.  That is, you may get some minimal level of medical coverage without much cost.  If you are not dirt poor, you may become that way if you assumed Medicare is going to cover every possible health need, and so you made no provisions.  It is better to know your costs and limitations than not know. Medicare does not cover everything.  It does not cover all the costs.  Some procedures are not covered or have limited coverage.  You have deductibles and co-insurance that you must pay.  Those costs may be significant, so you should know the limitations.  Then consider whether you need additional protection. For anyone who has had a serious illness or injury, you know how important it is to know what the insurance covers and doesn’t cover.  Medicare Part A deals with the most devastating costs.  They are in five main areas.  Inpatient Hospital Care, Blood, Hospice Care, Home Health Care, and Skilled Nursing.

Medicare HospitalInpatient Hospital Care

The hospital deductible is currently $1,260.  You pay the first $1,260 out of your own pocket before Medicare pays.  After that you have 100% coverage for 60 days.  You could potentially pay that deductible multiple times in the course of the year if you return to the hospital for inpatient care 61 days later or for another unrelated illness or injury.


Blood has its own separate line.  If the blood you receive comes from a blood bank, you may not have to pay for it.  You may simply be required to make a donation back to the blood bank later.  Or someone on your behalf.  The blood that is purchased, however, will cost you.  You are responsible for the first three pints.  After that, Medicare will cover you.

Hospice Care

Medicare covers hospice care when the doctor has determined that your life expectancy is six months or less.  What Hospice provides is PAIN RELIEF.  Everything—drugs, medical equipment, nursing, homemaker services—are all designed to reduce pain and maintain some reasonable level of comfort for the dying person.  Hospice is generally administered at home. An expectation that I have encountered is that people believe Hospice will cover room and board and other housekeeping items in a hospice or nursing home facility.  Those cost will be borne by the individual and/or family.  Not Medicare.

Medicare skilled nursingSkilled Nursing

Skilled nursing is not nursing home insurance.  It is not custodial care, which means bathing, transporting, feeding, etc.  Skilled nursing is medically necessary services AFTER a 3 day minimum inpatient hospital stay for a related illness.  Then the doctor discharges you to a facility because you cannot continue your treatment on your own.  For example: intervenes injections or physical therapy.  Again Medicare does not cover long term care or custodial care. Medicare does not cover every procedure.  It does not cover all the costs.  Some procedures are not covered or limited coverage.  You have deductibles and co-insurance that you must pay.  Those costs may be significant, so you should know the limitations first.  Then consider whether you need additional protection.  Know your costs and coverage limitations.  Call 402-614-3389 and/or email us for a free consultation and quote.  We will confirm whether you’re covered and if additional protection is right for you.

The ABD’s of Medicare

I learned to sing the alphabet before I learned to say it, and from that humble beginning, language opened up to me.  You can’t understand language without first understanding its alphabet.  Medicare has a language, and Medicare has an alphabet.  It begins with A, B, & D.  they are the three essential Components of Medicare.

letters-425000__180 A is for Medicare Part A.

A covers the hospital 100% for 60 days but only after you pay a $1,260 deductible out of your pocket.  Ouch!  Part A is free because you paid for it during your working years.  Eligibility for A is 3 months before your 65th birthday, the month of your birthday, & three months after.  If you don’t enroll then, there will be a penalty.


B is for Medicare Part B.

B covers doctor visits and outpatient procedures, such as, blood work, x-rays, emergency room, ambulatory surgeries, walkers, wheel chairs, oxygen tanks, etc.  Part B does cost something.  Currently $104.90 per month.    Medicare Part B pays 80% of the medical costs.  Your portion is 20%.  Important fact about your 20% co-insurance is that there is no cap.  As long as the bills roll in, your money rolls out.  Bigger Ouch!  The penalty for late enrollment for Part B is 10% for every 12 month period you do not enroll when eligible.  That 10% will be permanently added to your Part B premium.


D is for Medicare Part D.

The final letter is not C.  It’s D—D as in drugs.  Medicare Part D was started in 2006 after people complained about the crushing cost of medications.  Prescription drug plans are administered by private insurance companies approved by Medicare.  Prescription Drug Plans (PDP) can range in cost from $20–$70 per month with deductibles and co-pays.  There is a penalty for not enrolling in a Part D plan when you are eligible.  The penalty accrues each month you are not enrolled and is permanently added to your Medicare premium when you do enroll.

Medical expenses can be astronomical.  If the correct insurance is not in place with sufficient coverage, costs may surprise and overwhelm you.  Not following the eligibility requirements could result in surprise penalties and permanent premium hikes from Medicare.  Call 402-614-3389 or email us at for a free consultation to make sure all your letters are in place.

The Affordable Care Act (ACA) has left many Americans with questions, especially lately with many of the regulations going into effect for 2015. The ACA provides a Health Insurance Marketplace, designed to assist people who don’t otherwise have health coverage through their employer or otherwise. How does this all affect Omaha Medicare Recipients? The short answer is; nothing changes. If you currently receive Medicare, your choices and benefits remain the same. How so?

You can get more, for less. That’s right; if you are a Medicare recipient, you’ll be able to receive many types of preventive care at no additional cost, including services such as mammograms or colonoscopies. In addition, you’ll be able to receive one free wellness exam per year.

You’ll save money on prescription drugs. The “donut hole” that is part of the Medicare Part D program is a gap in your drug coverage that gives recipients 55% off of Part D-covered brand-name prescription drugs. This donut hole is steadily shrinking, and is expected to be closed by 2020, meaning recipients will only pay for 25% of their covered brand-name and generic prescription drugs.

Your Doctor will receive more support. The ACA has created new initiatives that support care coordination, ensuring that patients get the right care at the right time. As a result, your doctors will likely receive additional resources to ensure that your treatments are consistent.

Whether you receive Medicare through Original Medicare or an Omaha Medicare Advantage Plan, you will have the same benefits and security that you do now as a Medicare Recipient. Interested in learning more? Please contact Omaha Insurance Solutions at (855) 367-3631 to speak to a licensed insurance agent today.

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