Making Medicare easier

Most doctors, attorneys and accountants would agree that understanding 2013 Medicare costs and coverage isn’t easy. To get to the facts and simplify the difference between Medicare A and Medicare B, the Ridgefield Visiting Nurse Association asked Christina Crain, director of programs at the Agency on Aging in Bridgeport, to give a presentation at the Wilton Senior Center. On June 19, she offered a presentation to explain, clarify and end the confusion.

Medicare, helps pay for medical costs for U.S citizens with a sufficient work history under Social Security.

Medicare Part A covers inpatient hospital care, hospice care for the terminally ill and some care in a skilled nursing facility or home health services.

For Medicare A, an important thing to know is that coverage is for inpatient hospital care. If someone is admitted to the hospital “under observation,” they won’t be covered by Medicare. Patients have to be “medically” admitted.

Part A has a deductible of $1,184 per benefit period. Skilled nursing, home health and hospice have no deductibles. When a person has secondary, so-called Medigap, insurance, the insurer will pay a certain amount of Medicare costs.

If a patient goes to a nursing home after three days of hospitalization, Medicare A will pay for a maximum of 100 days of coverage. But on days 21-100, there is a $148 co-pay. After day 100, Medicare doesn’t pay anything.

Part B covers “ancillary” services, such as doctors’ services, outpatient hospital care, lab tests, medical equipment, orthotics and prosthetics, mental health care, ambulance service to the hospital, prevention and wellness screenings.

In 2013, those with a maximum income of $85,000 will pay $104.90 in monthly premiums, with a $147 annual deductible. With an income of $85,000 -$100,000, monthly premiums will be $146.90. The annual deductible will still be $147. It’s necessary to use “preferred” providers who accept Medicare. These providers are listed on the Medicare website.

Medicare’s home health care services must be prescribed by a physician. The patient must be homebound, but not bedbound.

Coverage should not be denied because the patient’s condition is chronic.  Physical therapy services shouldn’t be ended or reduced unless the therapist has deemed the patient has reached the rehabilitation goal that the therapist has set, or the therapist feels their client has reached their maximum rehabilitation potential and can’t further benefit from the rehabilitation services they are receiving.

There are many other details about coverage and costs. The Center for Medicare Advocacy, based in Connecticut and Washington, D.C., can answer many  questions. Visit

The Ridgefield Visiting Nurse Association will provide helpful information and referrals. Visit