(865) 588-3700 • Monica J. Franklin is a Certified Elder Law Attorney by the National Elder Law Foundation, the ABA approved entity for certifying attorneys as Specialists in Elder Law. info@monicafranklinelderlaw.com


Benefits Planning

Medicare | TennElderLawIt seems that every time we listen to the radio or television,

Medicare is the hot topic of the day.

With the aging of our society, we are all concerned about how much we will have to pay for our healthcare during retirement.While many believe the new law will entitle seniors to full prescription drug coverage, the reality is that the prescription drug coverage is limited.

What is Medicare?

Medicare is health insurance. It covers hospitalizations, doctors’ visits, medical equipment, some skilled nursing care, home healthcare, hospice and prescription medications.

What is the difference between Medicare and Medicaid?

Medi Care is health insurance for people age 65 and older and disabled persons who receive Social Security Disability Income (SSDI). MediCaid is a joint federal and state program that for our purposes helps pay for long-term care, if our client meets certain financial and medical qualifications.

What is Original Medicare?

Original Medicare is health insurance administered by the federal government. It is composed of Part A and Part B. Generally, people who qualify for Medicare do not pay for Part A. This benefit covers most of the expenses of hospital stays, skilled care in a nursing facility (up to 100 days per benefit period), hospice and some home health services.

People who remain enrolled in Original Medicare, also sign up for Part B. Medicare beneficiaries pay a set amount for Part B, but that amount usually changes each year. In 2015, for most people the Part B payment will be $104.90, and the Part B deductible is $147. When you enroll in Part B, the premium is withheld from your Social Security income.

Do I need Medi-gap or supplemental insurance?

Yes, people enrolled in Original Medicare, should purchase a “supplemental” or “Medi-gap” policy to cover the co-pays and deductibles not covered by Original Medicare, Parts A and B.

Do I need Part D insurance for my prescription medications?

Most Medi-gap policies and Medicare Advantage Plans include Part D insurance for prescription medications. However, read your policy carefully. If it does not include Part D, you will need to purchase Part D insurance separately.

What is a Medicare Advantage Plan?

These plans are offered by private insurance companies. A Medicare Advantage Plan rolls Medicare Parts A, B and supplemental insurance into one package. Usually the Medicare Advantage Plan includes Part D, but some do not, and you must purchase Part D separately. These policies are attractive because they generally cost less than a Original Medicare supplemental insurance policy.

Should I choose Original Medicare or a Medicare Advantage Plan?

This is a complex decision based on your care providers, your health, income and resources. However, there is free help for you through State Healthcare Insurance Program or S.H.I.P.

Does Medicare pay for my nursing home care?

Whether Medicare will pay for nursing home care depends on whether the you need skilled care and whether or not you had a three day “admission” to the hospital before entering the nursing home. Go to this link to learn more about the difference between the doctor classifying a hospitalization as “observation” vs. “admission” and why this is crucial to your continued good health and functionality:http://www.monicafranklin.com/assets/pdf/fall-2013.pdf

 Assuming that our client was “admitted” to the hospital for at least three midnights, and she needs skilled care, the client will be discharged to a skilled care facility for some type of skilled care such as physical, occupational, or speech therapy. This therapy is covered by the patient’s health insurance (Medicare) for a short period of time. Medicare pays 100% the first 20 days, and then from day 21-100, Medicare will pay 80%, and the Medi-gap policy will pay the co-payments.

After Medicare coverage ends, and you need further nursing home care, then you must pay from income, long-term care insurance, savings, Medicaid, or some combination of these resources. At Tennessee Elder Law, we help our clients access Medicare and public benefits, such as Medicaid and Veteran’s benefits need link to our medicaid and VA pages to help pay the cost of long-term care without “losing everything.” We have methods in our elder law tool box to preserve assets for our client first, and then to the extent possible, preserve assets for future generations

Where can I learn more about Medicare?photo

A great resource for understanding Medicare is the “Medicare and You”

MEDICARE AND YOU: the official U.S. Government Medicare Handbook
For assistance in choosing a Medicare supplemental policy, go to  http://www.tn.gov/comaging/ship.html