How the 2010 Law Affects Medicare
•Medicare Part B and D premiums
increase for
people with
annual income of
$85,000 for single people and
$170,000 for married couples.
Because these income amounts are NOT
indexed for inflation, the number of
Medicare Part B and Part D beneficiaries
who pay the higher premiums will increase each year.
Click for Example
Mrs. Smith is admitted to a nursing home in 2010. To pay for
her care, she cashes in savings bonds which create $60,000
of income. Added to her Social Security and pension income,
this puts her over the $85,000 limit, so she must pay
higher premiums for Medicare Parts B and D.
her care, she cashes in savings bonds which create $60,000
of income. Added to her Social Security and pension income,
this puts her over the $85,000 limit, so she must pay
higher premiums for Medicare Parts B and D.
• August, 2010: Medicare coverage for
an annual wellness visit
and a
personalized prevention assessment
and plan.
Prevention services include referrals
to education and preventive counseling
or community-based interventions to
address risk factors.
• 2011: Reduced payments to Medicare Advantage (MA)
plans by setting payments to different percentages
of Medicare fee-for-service rates,
with higher payments for areas with low FFS rates
and lower payments (95% of FFS)
for areas with high fee for service rates.
• 2011: Reduced Medicare reimbursement for
MRI, CT Scans,diagnostic imaging.
Reductions for ambulance service,
diagnostic labs, durable medical equipment.
• 2012: The 1.45% Medicare Payroll Tax
Will be
Increased to 2.35%
for people who earn over $200,000.
($250,000 married)
Medicare tax also levied on their net investment income
• 2012: reductions for dialysis treatment
• 2013: 2.3% Excise tax levied on
medical devices.
Exempt:
Eyeglasses and hearing aids
• 2014: Penalties begin for people who don't have
health insurance. See chart on home page.
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2010 Nursing Home Co-Pays
Medicare has co-payments for
each nursing home day.
Here's what the Original Medicare Plan
requires
you to pay for each benefit period
("spell of illness")
in a
Skilled Nursing Facility:
Days 1 - 20: No Co Pay;
Medicare pays all costs
Days 21 - 100
(Co-pays increase every year.)
2004 - $109.50/day
2005 - $114/day
2006 - $119/day
2007 - $124/day
2008 - $128/day
2009 - 133.50 /day
2010 - $137.50
Beyond the 100th day:
patient pays all costs
Remember: Medicare will only pay if the patient has spent
3 days in a hospital within 30 days of being
admitted to the skilled nursing facility.
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Explaining Co Payments for
Hospital and Medical Care
Explaining Co Payments for
Hospital and Medical Care
For many elders, the first source of payment for medical expenses is Medicare. Medicare Part A pays for inpatient hospital care, and for "extended care" in skilled nursing facilities, as well as hospice care, and home health care. Most people do not pay a monthly Part A premium, because they or a spouse has 40 or more quarters of Medicare-covered employment. For people who have only 30-39 quarters of Medicare-covered employment the Part A premium is $254.00 per month. The Part A premium is $461.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.
Medicare Part B medical insurance covers physician care. Most beneficiaries will continue to pay the same $96.40 premium amount in 2010. Because there is no Cost of Living Increase in Social Security Retirement benefits for 2010, Medicare laws prevent the government from raising Part B 
premiums for elders who currently have the Social Security Administration withhold their Part B premium and have incomes of $85,000 or less (or $170,000 or less for joint filers). But this protection does not apply to one in four (or about 11 million) beneficiaries who do not have their Part B premiums withheld from their Social Security checks, or
pay a higher Part B premium based on higher income, or
are newly enrolled in Part B. Medicare Chart showing premiums for higher income elders. For the higher income elders, the standard Medicare Part B monthly premium has increased to $110.50 in 2010. Medicare Fact Sheet.
Medicare Payments for Nursing Home Care. Medicare will not pay for any "extended care" in a nursing home, unless the elder was hospitalized for at least 3 days before being admitted to the skilled nursing facility (not counting the day of discharge). Admission to the nursing home must be within 30 days of the hospital discharge.
At some point, you or your family may be confronted by doctors, hospital discharge staff, or nursing home staff, who tell you that continuing long term care won't be paid for by Medicare, or provided by the hospital or nursing home. Our services include showing you how to coordinate your Medicare benefits with other sources of payment for elder care.
Medicare coverage provides payments for skilled care by hospital staffs and physicians. However, Medicare Part A Hospital Insurance will pay for only a limited number of days in a skilled nursing facility (see co payment chart in the side bar on this page).
The Medicare Regulations say that for Medicare to pay for the nursing home days "there must be an expectation that the beneficiary's condition will improve materially in a reasonable (and generally predictable) period of time based on the physician's assessment."
The Regulations also say "the determination of whether skilled nursing care is reasonable and necessary must be based solely upon the beneficiary's unique condition and individual needs, without regard to whether the or injury is acute, chronic, terminal, or expected to last a long time."
Examples: A patient with congestive heart failure may require continuous close observation to detect signs of decompensation, abnormal fluid balance, or adverse effects resulting from prescribed medication(s) that serve as indicators for adjusting therapeutic measures. Similarly, surgical patients transferred from a hospital to an SNF while in the complicated, unstabilized postoperative period, for example, after hip prosthesis or cataract surgery, may need continued close skilled monitoring for postoperative complications and adverse reaction. Patients who, in addition to their physical problems, exhibit acute psychological symptoms such as depression, anxiety, or agitation, may also require skilled observation and assessment by technical or professional personnel to ensure their safety or the safety of others, that is, to observe for indications of suicidal or hostile behavior. The need for services of this type must be documented by physicians' orders or nursing or therapy notes.
Your case deserves individual attention, to make sure you receive the full benefits provided by Medicare.
