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ELIGIBILITY - upon reaching age 65 & receiving Social Security retirement OR 25 months of receiving Social Security disability OR kidney failure with dialysis. Disabled individuals with ALS (Lou Gerig Disease) have the 25 month period waived. Part A - pays for hospital expenses, home health, rehab & skilled nursing home care & Hospice. No premium for most recipients. Hospital deductible - $952/per spell of illness Coinsurance - $248/day for the 61st thru 90th day. After 90 days you go into: Lifetime Reserve Coinsurance - $496/day for 60 remaining days of coverage Skilled Nursing Home Coinsurance - $124/day applies only for 21st to 100th day Part B - pays for doctor, outpatient services, durable medical equipment, ambulance & drugs that cannot be self-administered. Part B Premium - $93.50 month, withheld from Social Security payments Deductible - $131/yr -- BUT Beneficiary pays at least 20% of each Medicare charge Assignment not accepted = means Beneficiary must pay what Medicare does not pay Doctor submits all charges to Medicare for billing Part D - pays for prescription drugs as provided by the Prescription Drug Plan (PDP). Once must first be a Medicare beneficiary. There are 3 groups of coverage:
Part D Premium - for regular beneficiaries the cost will vary by plan. In NC, the costs run from $13 to $65/mo. - for low income subsidy recipients between 100 - 135%, if the plan chosen costs less than $36/mo, no cost for coverage. If plan chosen cost more, the recipient pays the difference. For recipients between 135 - 150%, a sliding scale up to $37/mo. - for dually eligibles, no costs. Deductible - for regular beneficiaries: $250/yr - for low income subsidy recipients between 100 - 135%: $0 - for low income subsidy recipients between 135 - 150%: $50/yr Co-payments - for regular
beneficiaries: see chart, will vary by Plan - for low income subsidy recipients between 100 - 135%: $2/generic $5 non - for low income subsidy recipients between 135 - 150%: $15% of drug costs - for duals: $1/generic $3 non-generic |
