All the hype about the new government health care plan has led many people to forget about what they already have available in existing Medicare. In the state of Michigan, residents not only are entitled to Medicare, but in some cases also receive Medicaid to help them with expenses that Medicare does not cover. It is always wise to have a secondary insurance that covers the things that Medicare will not and to help you through the “gap” period. This is the time when Medicare will not cover any of your prescriptions.
Medicare beneficiaries’ premium amount for 2010 is $96.40 which covers part B of your Medicare policy. Your yearly deductible amount is $155. The doctor or supplier may not accept the assigned amount that Medicare pays for their service. If the provider does not accept the assigned amount because their cost is higher than you are expected to pay the difference. In Michigan you are entitled to go to any doctor, specialist or hospital that accepts Medicare. Most providers accept the amount that Medicare allows for their services. Many seniors who have Medicare are also a member of AARP and have a secondary insurance that will cover the difference in cost.
Inpatient Hospital and Mental Care
Psychiatric hospital care services are paid the same as regular inpatient hospital care. Medicare in Michigan only pays for 190 day lifetime stay in a Psychiatric hospital. The “benefit period” starts the day you go into a hospital or skilled nursing facility. In 2010 the amounts for each benefit period are:
• Days 1-60: $1,100 deductible
• Days 61-90: $275 per day
• Days 91-150: $550 per lifetime reserve day
Residents of Michigan need to call 1-800-MEDICARE (1-800-633-4227) for information about lifetime reserve days. The Lifetime reserve days can only be used once. It ends when you go 60 days in a row without hospital or skilled nursing care. If you need to go into the hospital after one benefit period has ended then a new benefit period starts and so does your deductible for each benefit period. There are no limits to the number of benefit periods you can have.
Skilled Nursing Facility
In 2010 the benefit period after at least 3-day covered hospital stay is:
• Days 1-20: 0 per day
• Days 21-100: $137.50 per days
• You are allotted 100 days for each benefit period.
• The Benefit period starts the day you go into the hospital or Skilled Nursing Facility and ends when you go 60 days without hospital or Skilled Nursing Facility care.
*Home Health Care requires $0 co pay.
Many of us are concerned about the care we need when we do not need to be in the hospital or Nursing Care Facility. Medicare in Michigan has a fantastic program to help us with our outpatient care. For instance a doctor’s visit requires a 20% co-payment. Many people in the state have a coinsurance or perhaps Medicaid which is state funded. Since most seniors are members of AARP in the state of Michigan they usually carry a secondary insurance to pick up on the co-payments required. The following services require a 20% co-payment except Outpatient Mental Health Care which requires a 45% co-payment.
• Doctor Office Visits
• Chiropractic Services: Routine care not covered
• Podiatry Services: Routine care not covered
• Outpatient Substance Abuse Care
• Outpatient Services/Surgery
• Ambulance Services
• Emergency Care including doctor as well as the facility charge
• Urgently Needed Care
• Outpatient Rehabilitation Services
Those are just some of the services that Medicare provides for the beneficiaries in the state of Michigan. There are many others that you should check out depending on your circumstances and needs. You can find this information and much more by going to the Medicare website which is located at: