The Medicare Program
Medicare is a health insurance program for:
- People age 65 or older.
- People under age 65 with certain disabilities.
- People with End-Stage Renal Disease (permanent kidney failure requiring
dialysis or a kidney transplant).
The Original Medicare Has Two Parts
- Part A - Hospital Insurance.
Most people pay for Part A through their payroll taxes when they are
working.
- Part B - Medical Insurance.
Most people pay monthly for Part B.
You can elect to participate in a Medicare Advantage Plan Part C and Medicare Prescription Drug Coverage Part D
Medicare Advantage Plans
You can choose different ways to get the services covered by Medicare.
Depending on where you live, you may have different choices. In most cases,
when you first get Medicare, you are in the Original Medicare Plan. Or,
you may want to consider a Medicare Advantage Plan (like an HMO or PPO)
that provides all your Part A, Part B, and often Part D (Medicare Prescription
Drug) coverage. You make a choice when you are first eligible for Medicare.
Each year you can review your health and prescription needs and switch
to a different plan in the fall.
Medicare Advantage Plans are health plan options that are approved by
Medicare but run by private companies. They are part of the Medicare Program,
and sometimes called "Part C." When you join a Medicare Advantage
Plan, you are still in Medicare. As long as you have both Part A and Part
B, items covered by Part A and Part B are covered whether you have the
Original Medicare Plan, or you belong to a Medicare Advantage Plan (like
an HMO or PPO).
- Part D - Prescription Drug Coverage
Medicare Prescription Drug Plans are offered by insurance companies and
other private companies approved by Medicare.
Medicare Health Plans
Today's Medicare is about choice. Your health plan choices include:
- The Original Medicare Plan
- Medicare + Choice Plans, including:
- Medicare Managed Care Plans
- Medicare Private Fee-for-Service Plans
- Medicare Preferred Provider Organization Plans
Medicare + Choice Plans are available in many areas.
The Medicare health plan that you choose affects many things like cost,
benefits (some have extra benefits like prescription drugs), doctor choice,
convenience, and quality.
What is Medicare Part A?
Medicare Part A (Hospital Insurance) helps
cover your inpatient care in hospitals, including critical access hospitals,
and skilled nursing facilities (not custodial or long-term care). It also
helps cover hospice care and some home health care. You must meet certain
conditions.
Medicare Benefit & Cost information
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Most people do not pay a monthly Part A premium because they or a
spouse has 40 or more quarters of Medicare-covered employment.
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The part A premium is $244.00 per month for people having 30-39 quarters of Medicare-covered employment.
-
The
Part A premium is $443.00 per month for people who are not otherwise
eligible for premium-free hospital insurance and have less than 30
quarters of Medicare-covered employment.
- Medicare Part A Helps Cover Your Medically Necessary:
Hospital Stays
Semiprivate room, meals, general nursing, and other hospital services
and supplies. This includes inpatient care you get in critical access
hospitals and mental health care. This doesn't include private duty nursing,
or a television or telephone in your room. It also doesn't include a private
room, unless medically necessary. Inpatient mental health care in a psychiatric
facility is limited to 190 days in a lifetime.
Skilled Nursing Facility Care
Semiprivate room, meals, skilled nursing and rehabilitative services,
and other services and supplies (after a related 3-day inpatient hospital
stay).
Home Health Care
Part-time or intermittent skilled nursing care and home health aide services,
physical therapy, occupational therapy, speech-language therapy, medical
social services, durable medical equipment (such as wheelchairs, hospital
beds, oxygen, and walkers), medical supplies, and other services.
Hospice Care
For people with a terminal illness, includes drugs for symptom control
and pain relief, medical and support services from a Medicare-approved
hospice, and other services not otherwise covered by Medicare. Hospice
care is usually given in your home. However, Medicare covers some short-term
hospital and inpatient respite care (care given to a hospice patient so
that the usual caregiver can rest).
Blood
Pints of blood you get at a hospital or skilled nursing facility during
a covered stay.
What is Medicare Part B?
Medicare Part B (Medical Insurance) helps
cover your doctors' services and outpatient hospital care. It also covers
some other medical services that Part A doesn't cover, such as some of
the services of physical and occupational therapists, and some home health
care. Part B helps pay for these covered services and supplies when they
are medically necessary.
Medicare Benefit & Cost information
The
Medicare Premium for Part B is $96.40 per month. In some cases, this
amount may be higher if you didn't sign up for Part B when you first
became eligible. For additional details Click Here.
The cost of Part B may go up 10% for each 12-month period that you
could have had Part B but didn't sign up for it, except in special
cases. You will have to pay this extra amount as long as you have Part
B.
Medicare Part B Helps Cover Your Medically Necessary:
Medical and Other Services
Doctors' services (not routine physical exams), outpatient medical and
surgical services and supplies, diagnostic tests, ambulatory surgery center
facility fees for approved procedures, and durable medical equipment (such
as wheelchairs, hospital beds, oxygen, and walkers). Also covers second
surgical opinions, outpatient mental health care, and outpatient occupational
and physical therapy including speech-language therapy. (These services
are also covered for long-term nursing home residents.).
Clinical Laboratory Services
Blood tests, urinalysis, some screening tests, and more.
Home Health Care
Part-time or intermittent skilled nursing care and home health aide services,
physical therapy, occupational therapy, speech-language therapy, medical
social services, durable medical equipment (such as wheelchairs, hospital
beds, oxygen, and walkers), medical supplies, and other services.
Outpatient Hospital Services
Hospital services and supplies received as an outpatient as part of a
doctor's care.
Blood
Pints of blood you get as an outpatient or as part of a Part B covered
service.
What is the Original Medicare Plan?
The Original Medicare Plan is a "fee-for-service"
plan. This means you are usually charged a fee for each health care service
or supply you get. This plan, managed by the Federal Government, is available
nationwide. If you are in the Original Medicare Plan, you use your red,
white, and blue Medicare card when you get health care. If you are happy
getting your health care this way, you don't have to change. You will
stay in the Original Medicare Plan unless you choose to join a Medicare
+ Choice Plan.
Your costs in the Original Medicare Plan
What you pay out-of-pocket depends on:
- Whether you have Part A and Part B
- Whether your doctor or supplier agrees to accept "assignment"
- How often you need health care
- What type of health care you need
- Whether you choose to get services or supplies not covered by Medicare.
In this case, you would pay for these services yourself.
- Whether you have other insurance