The first 20 days would be paid for in full by Medicare with the remaining 80 days requiring a co-payment of $167.50 per day as of 2018. Many insurance group retiree, Medigap and Part C insurance plans have a provision for additional coverage of skilled nursing care in the indemnity insurance policies they sell or health plans they sponsor. If a beneficiary uses some portion of their Part A benefit and then goes at least 60 days without receiving facility-based skilled services, the 90-day hospital clock and 100-day nursing home clock are reset and the person qualifies for new benefit periods.
Since the Medicare program began, the CMS (that was not always the name of the responsible bureaucracy) has contracted with private insurance companies to operate as intermediaries between the government and medical providers to administer Part A and Part B benefits. Contracted processes include claims and payment processing, call center services, clinician enrollment, and fraud investigation. Beginning in 1997 and 2005, respectively, these Part A and B administrators (whose contracts are bid out periodically), along with other insurance companies and other companies or organizations (such as integrated health delivery systems, unions and pharmacies), also began administering Part C and Part D plans.
In 2018, Medicare provided health insurance for over 59.9 million individuals—more than 52 million people aged 65 and older and about 8 million younger people. On average, Medicare covers about half of healthcare expenses of those enrolled. Despite often being called single-payer, United States Medicare is funded by a combination of a payroll tax, beneficiary premiums and surtaxes from beneficiaries, co-pays and deductibles, and general U.S. Treasury revenue. In addition, per the Medicare Trustees, almost everyone on Medicare adds private or public supplements to so-called Original Medicare, which have additional premiums and co-pays. Instead of being single payer, some people on United States Medicare have as many as six payers including themselves.
A Medicare Part D Prescription Drug Plan (PDP) can help pay your prescription drug costs. Designed to work alongside Original Medicare coverage, Medicare Prescription Drug Plans are available from private insurance companies approved by Medicare and doing business in Minnesota. You can also enroll in a Medicare Prescription Drug Plan if you enroll in a Medicare Advantage plan that does not include Part D prescription drug coverage in its benefits.
As long as you buy a Medigap plan during this six-month Medigap Open Enrollment Period, the insurance company cannot refuse to sell you a Medigap policy, charge you more because you have health problems, or make you wait for basic benefits to begin. However, you may have to wait up to six months for the Medigap policy’s benefits to include your pre-existing condition*. Original Medicare will generally still cover a pre-existing condition even if your Medicare Supplement insurance plan doesn’t pay for your out-of-pocket costs.
Different insurers cover prescriptions differently, so you may find that one company or another does a better job of helping you pay for your medicine. This might not always be the insurer that offers you the lowest rates for your medical coverage. Note that insurers may change their drug plans each year, so it’s a good idea to make sure that these changes won’t negatively impact you. With Medicare Part C plans in Minnesota, you will have to change all of your coverage if you want to change your drug plan, and with supplement plans, you can just change your drug plan.