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Now that you’ve learned about Medicare Part A, you may also be wondering what Part B can do for you. While Part A will help you with things like hospital stays and skilled nursing facility care, Medicare Part B helps with other areas in which you may need coverage. Find out what Medicare Part B covers and if it’s for you.
What does Medicare Part B cover?
You may remember that in Part A, we explained Original Medicare is the term used when a plan combines Part A with Part B. That’s because in addition to the benefits Part A will give you, Part Bcovers clinical research, ambulance services, durable medical equipment, mental health (inpatient, outpatient, and partial hospitalization), the ability to get a pre-surgery second opinion, and limited outpatient prescription drugs.
If you aren’t eligible for premium-free Medicare Part A, not to worry; you can buy Part B without having to buy Part A. Here are the qualifications you need to meet:
• 65 years or over
• A U.S. Citizen or permanent resident who has legally been in the country for five consecutive years
When should I enroll?
Much like with Medicare Part A, Part B’s has a seven-month Initial Enrollment Period. This means anywhere between the three months prior to month you turn 65, and the three months after that. For example, if your birthday is in April, you are eligible from January through July.
However, if you don’t sign up within that time, you may have to pay a late enrollment penalty for the entire time you have Part B. According to Medicare.gov, “Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B, and coverage will start July 1 of that year.”
How much does it cost?
If you signed up for Part B when you became eligible, then you’ll likely pay a $104.90 premium each month, according to Medicare.gov. Though, this premium can change based on your income, and recent reports indicate it will cost more for a few select groups in the future.
There are some people who automatically get Part B. If you receive Social Security benefits, Railroad Retirement Board (RBB) benefits, are under 65 years old with a disability, have ALS, or live in Puerto Rico and receive Social Security or RBB benefits, then you are eligible for automatic enrollment.
About Transamerica Center for Health Studies®. The Transamerica Center for Health Studies® (TCHS) is a division of the Transamerica Institute®, a nonprofit, private foundation. TI is funded by contributions from Transamerica Life Insurance Company and its affiliates and may receive funds from unaffiliated third parties. TCHS is dedicated to identifying, researching and analyzing the most relevant health care issues facing consumers and employers nationwide. For more information about TCHS, please visit www.TransamericaCenterforHealthStudies.org.
Medicare can be confusing, but don’t worry. You aren’t the only one feeling that way. Although there are many benefits to Medicare, with its different components and enrollment periods, it can get a little confusing. In this three-part series, we’ll break down Parts A, B, C and D of Medicare down to their essentials. Here are simple answers to the most-asked questions about Part A:
What does Medicare Part A cover?
Medicare Part A combined with Part B, make up what is known as Original Medicare. Part A covers emergency care, hospital stays, some nursing home care, and other long-term visits such as home health services and hospice care.
Seniors (age 65 and above) who are U.S. citizens and permanent residents.
Individuals with qualified disabilities (age 64 and below).
When should I enroll?
You can enroll during your Initial Enrollment Period (IEP), which usually lasts 7 months:
Three months before your 65th birthday or 25th disability check.
Month of your 65th birthday or 25th disability check.
Three months after your 65th birthday or 25th disability check.
If you miss your Initial Enrollment Period, you can sign up during the General Enrollment Period, which is from January 1 to March 31. If you sign up during this time, your coverage will start July 1. Please note that if you enroll during the General Enrollment Period you may have to pay a higher premium for late enrollment.
Fall Open Enrollment occurs every year between October 15th and December 7th and allows those who already have Medicare to change their coverage. We recommend you review your coverage every year, as this is the one time when all people with Medicare can make changes to their plans for the next year.
How much does it cost?
Part A plans are provided to you at no cost if you or your spouse have worked and paid taxes for at least 40 quarters (or 10 years).
If this isn’t the case, you will pay a monthly premium of up to $407. The exact amount you’ll pay is determined by different factors such as your income and assets.
If you’re concerned about the costs involved that aren’t covered by Medicare, Medicare Supplement Insurance can help cover expenses that you’ll have to pay out of pocket.
The Transamerica Center for Health Studies® (TCHS) is a division of the Transamerica Institute®, a nonprofit, private foundation. TI is funded by contributions from Transamerica Life Insurance Company and its affiliates and may receive funds from unaffiliated third parties. TCHS is dedicated to identifying, researching and analyzing the most relevant health care issues facing consumers and employers nationwide. For more information about TCHS, please visit www.TransamericaCenterforHealthStudies.org.
Cancer is the general name for a group of more
than 100 diseases. Although there are many kinds of cancer, all cancers start
because abnormal cells grow out of control. Untreated cancers can cause serious
illness and death.
Lifetime Risk of
Developing or Dying From Cancer:
The lifetime risk of developing or dying from
cancer refers to the chance a person has, over the course of his or her
lifetime (from birth to death), of being diagnosed with or dying from cancer.
These numbers are average risks for the
overall US population. Your risk may be higher or lower than these numbers,
depending on your particular risk factors.
Risk of developing
Risk of dying from
All invasive sites
Risk of developing
Risk of dying from
All invasive sites
Impact of Cancer
The financial costs of
cancer are high for both the person with cancer and for society as a whole.
Agency for Healthcare research and Quality (AHRQ) estimates that the direct
medical costs (total of all health care costs) for cancer in the US in 2011
·50% of this cost is for hospital
outpatient or doctor office visits
·35% of this cost is for inpatient
·11% of this cost is for prescription
*PLEASE NOTE: These estimates are based on a set of large-scale
surveys of individuals and their medical providers called the Medical
Expenditure Panel Survey (MEPS). Estimates were accessed directly from the MEPS
One of the major costs of cancer is cancer treatment. But lack
of health insurance and otherbarriers to health
care prevent many Americans from getting optimal health care.
·According to the US Census Bureau,
about 48 million people (15.4%) in the US were uninsured in 2012.
·About 10% of children in the United
States had no health insurance coverage in 2012.
And according toCancer Facts & Figures 2015,
“Uninsured patients and those from ethnic minorities are substantially more
likely to be diagnosed with cancer at a later stage, when treatment can be more
extensive, more costly, and less successful.”
This year, about 589,430
US residents are expected to die of cancer – that’s more than 1,600 people a
day. Cancer is the second most common cause of death in the US, exceeded only
by heart disease. Cancer accounts for nearly 1 out of every 4 deaths in the
Cancer costs us billions
of dollars. It also costs us the people we love. Reducing barriers to cancer
care is critical in the fight to eliminate suffering and death due to cancer.
American Cancer Society.Cancer Facts & Figures 2015.
Atlanta, Ga. 2015.
Last Medical Review: 04/15/2015 Last Revised: 04/15/2015
can we help? || SBS Client Testimonies:
1. "I am 70 years old and on Medicare. I also have a good
Medicare supplement. When I was diagnosed with Cervical cancer 3 years ago. I
knew the medical bills would be covered. However, the treatment, (Chemo
therapy and radiation for 8 weeks) was at a cancer center 180 miles from
home. That’s when I found out how valuable my cancer insurance proved to
be. The motel bill for two months, the travel expenses, eating out, even
someone to take care of the house while we were gone were all taken care
of with the funds we received from the cancer insurance policy. Our
daughter took time off work to be with me and we were able to cover her
expenses too. We had the peace of mind that all the unexpected expenses
were covered. It was a stressful time but the cancer insurance sure eased the
- Virginia (Missouri)
2. "I have carried
Medicare Supplement Insurance with SBS for 8 years. When my agent spoke
to my husband and I about the value of a cancer policy, and we saw how
inexpensive the coverage was, we decided to move forward with the
plans even though we knew our supplements would cover the majority of the
medical bills. Less than 3 years after purchasing the policy I was diagnosed
with breast cancer. Within 2 months of filing the claim after my
diagnosis, I had a check in my hands from GTL Insurance Company for $5,000.
That money was such a blessing at a time that was
both financially and emotionally difficult!"
- Lula Bell U. (Missouri)
3. "I purchased my GTL cancer plan in
November of 2010. By September of 2011 I had been diagnosed
with internal cancer. I was so relieved when I received my $5,000
check from my cancer plan, after having the policy for less than a year!
We were under such serious financial strain at the time, with our
home recently being condemned because of black mold, we didn't know what we
were going to do. We were able to use that money for the deposit and
rent on a new apartment. I can't thank our agent enough for stressing
the importance of carrying cancer insurance."
While the Obama Administration has yet released its 2016 Medicare Part B costs. But due to a Social Security provision, known as the hold harmless rule, about 30 percent of Part B enrollees may face premium increases.
Typically, those who have claimed Social Security benefits and receive Medicare must, by law, have their Part B premiums withheld from their Social Security payments. And due to the hold harmless rule, Social Security benefits can’t decline year-to-year.
Generally, each October, the Social Security Administration (SSA) announces a cost of living adjustment (COLA) for the following year. Therefore, when Medicare announces any Part B premium increases, these higher payments are simply taken out of beneficiaries’ COLA-adjusted Social Security benefits. As of now, this proposal has not yet been passed.
Lower COLA, higher premiums
In 2016, the COLA is expected to be zero (see chart below). This won’t impact the majority of Medicare beneficiaries who fall under the hold harmless rule. By law, they won’t face any premium increases next year. Instead, they’ll continue to pay the current premium of $104.90.
However, Medicare still has financial responsibilities and can’t just absorb any increases. In fact, the law states that beneficiaries are responsible for roughly 25 percent of Medicare Part B’s expenses. These costs must be paid by those not shielded by the hold harmless rule. Current projections suggest that these beneficiaries face a 52 percent increase in 2016 Part B premiums. Among these are:
Those who haven’t received Social Security benefits yet, but pay their Medicare premiums directly to Social Security
Low-income beneficiaries, with premiums paid by their state. As they’re not held harmless, state budgets would be impacted in 2016
For the 30 percent of beneficiaries not held harmless, the monthly premium increases from $104.90 to $159.30. For higher-income premium groups, 2015’s monthly premium range of $146.90-$335.70 increases to a monthly range of $223-$509.80 in 2016. Trustees expect that the Part B Medicare annual deductible would also increase by 52 percent in 2016, from $147 to $223. These increases would apply to Original Medicare (Parts A and B), as well. The exceptions would be those with Medigap Plans C and F; those plans pay these deductibles.
Explore your payment options
Any COLA-related increases have not formally passed yet. But once they do, those affected must pay the higher premiums. As such, those paying their premiums directly to Social Security should sign up for Social Security before the end of the year. They should also begin having their Part B premiums automatically deducted from their Social Security payments. By doing so, these beneficiaries should be held harmless in 2016.
However, as taking Social Security benefits early has its pros and con, consider this option carefully. All enrollees have a seven-month window, extending before and after their 65th birthday. So, it may be helpful to hold off on enrolling in Part B until 2017.
For now, Medicare officials are researching how to reduce these increases, while still ensuring funding for Part B expenses. You should know that any COLA-related increases aren’t permanent. Part B premiums should change in future years. Therefore, beneficiaries held harmless in 2016 would pay more in subsequent years. Those not held harmless in 2016 would have their premiums decrease. And eventually, all members without an income-based premium surcharge would pay the same Part B premium.
Three diseases, leading killers of Americans, often involve long periods of decline before death. Two of them — heart disease and cancer — usually require expensive drugs, surgeries and hospitalizations. The third, dementia, has no effective treatments to slow its course. So when a group of researchers asked which of these diseases involved the greatest health care costs in the last five years of life, the answer they found might seem surprising. The most expensive, by far, was dementia. The study looked at patients on Medicare. The average total cost of care for a person with dementia over those five years was $287,038. For a patient who died of heart disease it was $175,136. For a cancer patient it was $173,383. Medicare paid almost the same amount for patients with each of those diseases — close to $100,000 — but dementia patients had many more expenses that were not covered. On average, the out-of-pocket cost for a patient with dementia was $61,522 — more than 80 percent higher than the cost for someone with heart disease or cancer. The reason is that dementia patients need caregivers to watch them, help with basic activities like eating, dressing and bathing, and provide constant supervision to make sure they do not wander off or harm themselves. None of those costs was covered by Medicare.
A recent The New York Times article, "Costs for Dementia Care Far Exceeding Other Diseases, Study Finds," reports that for many families, the cost of caring for a dementia patient will in many cases consume all of their household wealth.
Most families just aren't prepared for the financial burden of dementia. They assume that Medicare cover all of the expenses. Not so. Patients and their families don't realize that isn't the case. Plus, everything gets more complicated when an individual has dementia.
For example, if a dementia patient in a nursing home gets a fever, the staff may say that they aren't equipped to handle it. They call 911. The patient is then admitted to the hospital. This can lead to complications for the patient suffering from dementia. They may get delirious and confused, slip or fall out of bed and sustain injuries, or they choke on their food. This can cause medical costs to sky-rocket.
There are large disparities in out-of-pocket costs for the three diseases. Medicare covers discrete medical services like office visits and acute care, including hospitalization and surgery. These are the types of expenses experienced by cancer patients and heart patients. Those patients usually don't need full-time home or nursing home care until the very end of their life, if at all. As a result, they don't see that continuing cost. On the other hand, dementia patients need constant care for years. In addition, these dementia patients may not be sick enough for a nursing home, but they still will need supervision and care.
When dementia patients are sick enough for a nursing home, the cost is not covered by health insurance. More than half of patients with dementia— with three-quarters of those from racial minorities—spend down, using savings to pay for the nursing home until the money is all gone. After that, Medicaid takes over.
Talk with an experienced elder law attorney about care for the elderly, Medicaid, and dementia. He or she will have ideas on how to best address your family's situation.