Health Care Insurance and Cost Management - Medicare and Medical Expenses

Part B - Medical Expense
This part of Medicare covers most medical expenses not covered in Part A of the plan. This part of the plan is always voluntary and requires that the participant pay monthly premiums.


Covered Expenses

Excluded Expenses
Physicians and surgeons services Self administered drugs
Diagnostic tests Routine physical, eye, and foot exams
Radiology/pathology Routine dental care
Physical therapy Cosmetic surgery
Drugs that cannot be self administered Eyeglasses
Blood transfusions Custodial care
Outpatient services Immunizations - except Pnemococcal
Rental of medical equipment
Cancer screenings
Prosthetic devices
Home health care - when not covered under Part A


Part B Expenses Covered
Deductible $131 yearly
Co-Insurance 20% of the approved amount (Medicare 80%)

Home Health Care
Cost
$0 for care
20% for durable medical equipment

Clinical and Laboratory
Cost $0 for approved services

Mental Health
Cost 50% for outpatient

Blood
Cost
100% of the first 3 pints
20% for any additional pints

*All numbers are as of the 2007 plan documents

Part D - Prescription Drug
Prescription drug coverage is available to those covered under Medicare Part A and Part B through private insurance companies. Since this plan is offered by private companies the costs may vary. A covered individual pays a monthly premium and the costs illustrated below.
  • Deductible $265 Participant Pays
  • Next $2,400 Participant Pays a Co-payment and Co-insurance
  • Participant pays 100% until he /she pays $3,250 out of pocket
  • Participant Pays a co-insurance of 5%

There is assistance available to seniors with low incomes with Part D coverage. The assistance can include a premium waiver, deductible waiver, and/or reduced co-pay.

Medigap insurance - Medicare Supplement
This policy is designed to make up the difference between what the participant has to pay and what the Medicare policy pays. These policies will pay a portion, if not all, of the participant's deductibles and co-insurance associated with their Medicare policy.
Taxation of Premiums and Benefits
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