How Medicare Works

A person receiving Medicare is also known as a beneficiary. Beneficiaries who also have other health insurance must coordinate which program pays first. In some situations, the beneficiary’s own insurance must pay first, and Medicare may cover some of what’s left. Most individuals going through treatment for mesothelioma are eligible for Medicare.

The Affordable Care Act extends Medicare coverage to families with low incomes. The act designates a mandatory minimum across the United States. For most of the population under 65, income may not exceed 133% of the federal poverty level. In 2021, that’s about $12,880 gross annually for one person. For a family of four, gross annual income may not exceed $26,500.

Some programs extend coverage to groups with an immediate need.

Medicare Payments for Mesothelioma Patients

Old man talks with his doctor over medical paperwork.

Depending on what plan and coverage patients select, they may have to pay varying copayments, coinsurance, or deductibles. The program has maximum payment limits and doesn’t cover some health services. In this case, patients have to supplement the remaining costs.

Types of Assistance

Medicare coverage is available to mesothelioma patients in four parts. They may choose to sign up for one or all depending on need and accessibility. Part A and B are known as “Original Medicare” and cover the majority of costs of inpatient and outpatient care.

Part C and D are purchased separately as a type of add-on, and premiums range on the patient’s income. Also known as part of the “Medicare Advantage Plan”, Part C and D are alternatives to the Original Medicare. Someone with private insurance that covers both A and B may enroll in part C or D. Or both. Some private insurances cover A, B, C, and D.

Part A – Inpatient care – Hospital stays, limited specialized nursing care, hospice support, home healthcare.

Part B – Outpatient care – Hospital visits, physician appointments, preventative support, some medical tools.

Part C – Run by private insurers. Can include extra medical support like dental, vision, and prescription drugs.

Part D – Run federally and also helps cover the cost of prescribed medications. For mesothelioma, Part D may cover oral chemotherapy, anti-nausea, and palliative medications.

Medicare doesn’t cover:

  • Daycare for adults
  • Rooms in assisted living facilities
  • Long-term nursing home assistance
  • Medical food or supplements
  • Assistance with day-to-day services

Eligible adults may enroll for Medicare during the allotted period after their 65th birthday. Those with group health insurance plans from their spouse’s current job might not need Part B coverage.

2021 Costs

Since the government funds Medicare, the program is mostly free to enroll in if you’ve worked in the United States and paid taxes into the program long enough. While it’s free to enroll in for most, that doesn’t mean that the program fully covers the patient’s medical expenses. Like private insurance, patients will pay a certain amount monthly, and Medicare will cover the rest. The amount owed depends on the patient’s income and need.

Part A Premium
  •  This part is also known as “premium-free Part A” because most don’t pay a premium for this part. In 2021, the max out-of-pocket payment for patients will be approximately $471.
  • Beneficiaries < 30 quarters of paid Medicare taxes must pay a $471 premium.
  • Beneficiaries > 30-39 quarters of taxes pay less of a premium, at $259.
Part A Hospital Inpatient Deductible and Coinsurance
  • $1484 deductible
  • $0 coinsurance first 60 days
  • $371 coinsurance on days 61 through 90
  • $742 coinsurance after 91 days
Part B Premium
$148.50
Part B Deductible and Coinsurance
$203 deductible. After this is paid, the beneficiary usually covers 20%.
Part C Premium
Varies on the plan chosen
Part D Premium
Varies on the plan chosen

Medicare Versus Medicaid

Medicaid is another program run by CMS that helps people cover medical expenses. Benefits patients may attain change by state, but they generally include compensation for:

  • Lab tests and X-rays
  • Inpatient / outpatient hospital visits
  • Family planning
  • Medical support for children
  • Nursing facilities for adults
  • Surgical dental for adults

Patients that are eligible for Medicare may also be eligible for Medicaid and are known as “dual eligible”.

Need Help Signing Up for Medicare?

Besides issuing Medicare, CMS also advocates for patients and adults who need access to the program. This involves providing auxiliary aids and services, free of charge. Aids encompass helpful information that’s produced in accessible formats like:

  • Braille
  • Large print
  • Data audio Files
  • Relay Services
  • Teletypewriter (TTY) Communications

Mesothelioma patients interested in Medicare or Medicaid can contact CMS to request accessible information.

The Centers for Medicare and Medicaid Services (CMS)
Social Security

Other Compensation Options for Mesothelioma Patients

Senior citizen discusses his benefits with a Medicare advisor on a sofa

Most patients that develop mesothelioma were unknowingly exposed to a toxic mineral known as asbestos sometime in their life. Since it’s been used as a fire retardant in building and construction materials for decades, it can still be found in dangerous capacities today. Even so, diseases like mesothelioma may take decades to develop.

The Environmental Protection Agency (EPA) and other government organizations put strict regulations in place to protect workers and residents from harmful and negligent exposure to the mineral. Since these rules are in place, patients with mesothelioma or other asbestos-related diseases may qualify for other compensation options besides Medicare. Every person has rights. If someone develops mesothelioma from asbestos exposure, they can file a legal claim towards the company or entity responsible if they can’t attain support from the Medicare program.

Other compensation options that legal help can attain for a mesothelioma patient include:

Asbestos Trust

When companies with significant asbestos issues deal with multiple lawsuits, they may eventually go bankrupt. If an organization with known asbestos litigation has to file a Chapter 11, they may put an asbestos trust in place. This is to compensate future people who may sue their company for the same reasons.

Personal Injury

Patients that develop mesothelioma from exposure to asbestos while at work may file a personal injury claim against the companies responsible.

Settlement

If a patient files a claim against a company because of asbestos exposure, the company can choose to settle. When they do this, they are agreeing to compensate the patient based on terms that both parties have agreed on. If both groups can’t find a common ground, the case will move to court. Here is where the judge will hear both sides and come to a verdict. 

Workers Compensation

Workers Compensation, also referred to as “workers’ comp,” is a social insurance program in the US. Most employers offer some form of this program, as it’s mandatory by law. Each state does have its own specifications about the program, however.

Wrongful Death

In a situation where the mesothelioma patient has already passed away, their immediate family may choose to file a wrongful death claim against the company responsible for asbestos exposure.

The money the patient or their family may attain from litigation or settlement can go towards many things. For instance, supplementing loss of income from illness, paying for related treatments, transportation, and services, and supporting their family. Contact an attorney that specializes in mesothelioma litigation if Medicare isn’t an option.

Medicare Recovery Claims or “Liens”

A medical recovery claim otherwise known as “lien”, is when Medicare money already paid is recovered or taken back by the issuer. When someone enrolls in Medicare, receives compensation, takes legal action, and receives compensation from that, CMS will issue a recovery claim. This is because, by law, Medicare may not pay for a beneficiary’s (mesothelioma patient) medical costs when they are already going to receive (or are expecting) other medical payments.

Payments eligible for a lien can be compensation from mesothelioma litigation, private insurance, state agency, provider, physician, or supplier. Seeking alternative compensation for medical costs related to mesothelioma is only recommended when the patient for some reason, cannot attain funds from the Medicare program, or still can’t afford to pay after their Medicare contributions. When this is the case, the patient can avoid enrolling in Medicare and just seek legal or other compensation instead. Monetary aid gained from litigation usually can cover all related expenses.

If a beneficiary receives both Medicare and other compensation, CMS may issue a recovery claim or lien. The patient may have to pay some of their Medicare compensation back. If this happens, a lawyer can help negotiate the amount the beneficiary will have to pay back.

What Happens After I Apply for Medicare?

Once enrolled, the CMS will send a welcome packet and Medicare card. Inside will include helpful resources regarding coverage and related options.

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