The Elder Law Forum

The Elder Law Forum by Professor Michael Myers Editor's Note: The Elder Law Forum is a public service of the University of South Dakota School of Law, an extension of the SENIOR LEGAL HOTLINE available at no cost to persons 60 and older at 605-677-6343 and during regular business hours. The Elder Law Forum delivers information and educational material by radio, a weekly newspaper column, and Law School research papers placed on the USD School of Law Web site. Professor Myers teaches Elder Law at the School of Law.

Medicare covers half

of beneficiary costs

"Medicare itself only covers 54 percent of the average beneficiary's healthcare costs." That sobering statistic was delivered to the Elderlaw Forum radio audience this week by Michael Parker, attorney for the Division of Adult Services and Aging, Pierre.

"Medicare is a good program," said Parker, "but beneficiaries must understand its limitations."

Healthcare inflation has imposed upon the elderly an ironical reality: The average Medicare beneficiary pays more out-of-pocket for physician and hospital services today than before Medicare was enacted, even when adjusted for inflation. And, Medicare premiums, deductibles and copays continue to rise.

For 2003, the Medicare Part B premium is $58.70 per month, up from $54 last year. The Part A (hospital) deductible is $840, compared to $812 in 2002. Part A co-insurance for days 61 through 90 is $210 per day, up from $203, and for days 61 through 150 and lifetime reserve days, $426 per day, up from $406 last year. These copays and deductibles can be insurmountable for a person who encounters a major illness. Part B, which covers medical and hospital ambulatory care, imposes a 20 percent across-the-board copay on beneficiaries.

A Medicare beneficiary cannot afford to be without a Medicare supplemental (Medigap) policy. Mr. Parker reports that Plan F remains the most popular type of policy. Its cost, at age 65, ranges from $796 (Avera Select, with network restrictions) to $1,886 annually. Mutual of Omaha markets a Plan F product for $938, according to Parker.

Plan F pays 100 percent of the Medicare "excess charge," the difference between the physician's fee and the approved amount paid by Medicare. Also it includes a foreign travel and emergency benefit. But remember, Medigap policies are tied to the basic Medicare benefit package. If Medicare does not cover the treatment, neither does your Medigap policy. For example, if you desire prescription drug coverage, you must purchase a separate rider.

The 2003 update from the Centers for Medicare and Medicaid Services reflects Medicare's expanded coverage for services considered to be "preventive." They include bone mass measurements, colorectal cancer screening, diabetes services and supplies, glaucoma screening, mammogram screening, pap test and pelvic examination (including breast exam), prostate cancer screening, and certain vaccinations.

It should be noted that all people with Medicare who have diabetes � both insulin users and non-users � now have coverage for glucose monitors, test strips, and lancets. Also Medicare will pay for diabetes self-management training.

Many of the preventive services are limited in their scope and frequency. Specific information is available through the USD Senior Legal Hotline, 605-677-6343.

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