Medicare is a federal program that provides medical insurance for older people and persons with disabilities and covers most doctors’ fees. Each state has adopted the Medicare program, even though it is based on the same federal legislation passed in 1965. The program is funded by general tax revenues, which are received from a payroll tax deduction, along with beneficiary premiums and general revenues.
When you sign up for Original Medicare, you’ll be able to choose from one of Basic, Standard, Enhanced or Gold levels of coverage. Each level comes with different monthly premiums based on your income level.
Medicare has many parts because it provides various services to our country’s elderly and disabled. Medicare has four parts.
- Part A
Part A covers inpatient hospital services, including overnight stays and ER visits. Part A also covers outpatient procedures like doctors’ visits and diagnostic tests. The Department of Health and Human Services determines what services are covered by Part A, but it does not cover long-term care or home health care.
Medicare Part A pays for all medically necessary services covered by Medicare, including:
• Hospice care
• Durable medical equipment (such as a wheelchair)
• Home health care; ambulance transportation
• Skilled nursing facility care
• Intermediate care facility for the mentally disabled (ICF/MR)
• Inpatient mental health services
• Dialysis treatment; hospice in payment group 1-5
• Other supplies related to the above items.
Part A covers 80% of the cost of covered benefits. The remaining 20% is paid out of pocket by you or your family members if they’re responsible for paying the bill.
- Part B
Medicare Part B is a program that helps individuals pay for medical services, prescription drugs, and other related costs. It covers most of your doctor’s costs, but you’ll need to pay a monthly premium of $134.90. Some of the expenses that it can cover include:
• Medical services
• Prescription drugs
• Durable medical equipment and supplies
• Preventive care services
• It also covers some services not covered by the Original Medicare (including hospice care) and some more expensive services than those covered under Part A.
- Part C
Medicare Part C is a Medicare health insurance supplement that provides coverage for outpatient prescription drugs and some medical supplies.
Part C excludes hospital care, medical equipment, and other items that Medicare typically covers. For example, part C does not cover long-term care services. Furthermore, it does not cover any pre-existing conditions or requires you to pay out-of-pocket for doctor’s visits.
If you enroll for Part C, your health plan will cover all of the costs associated with your medication through a monthly premium paid by you or a monthly deductible paid by the plan. You must also pay an annual deductible of $1,000 if you want to receive drug coverage until age 65.
If you do not meet these criteria or have an income above certain levels (such as $85,000 or more), premiums may be higher than normal, and cost-sharing could increase significantly.
- Part D
Medicare Part D is a federal program that provides prescription drug coverage for seniors and people with disabilities. It also offers information about which medications are covered by Medicare, how much you’ll pay for them, and how to get discounts on prescription drugs.
Part D covers outpatient prescription drugs for chronic diseases like diabetes and high cholesterol. However, it does not cover inpatient care or rehabilitation services such as physical therapy, occupational therapy, speech therapy, or home health services.
- Medicare Supplement Plans
Medicare Supplement Plans are insurance policies that supplement Medicare benefits. People who have Medicare or those who do not have Medicare but are eligible for it can purchase it. The plans are voluntary, meaning you can choose to have one without signing up for it through Medicare. However, you must still meet the Medicare eligibility requirements before enrolling in a Medicare supplement plan. If you already have a Medicare supplement plan, you may use it until your original policy no longer meets the Affordable Care Act (ACA) requirements.
Why Do You Need Medicare?
It pays for medical services and supplies you have not paid for out of pocket, including hospital and doctor visits and prescription drugs. Medicare helps you pay your medical bills if you have a low income, no income source, or a disability.
Medicare is important because it helps seniors pay their medical bills when they are sick or injured. Sometimes Medicare will pay all or part of your medical bills if you are 65 years old or older. You may also be eligible for Medicare if you have worked long enough in the United States to qualify for Social Security disability benefits.
What Does Medicare Not Cover?
Medicare covers hospital and outpatient care and some home health services. It also covers prescription drugs, but Medicare covers not all prescriptions.
If you have private insurance or a high-deductible health plan, Medicare may not cover everything your doctor sees you for. For example, if you need surgery or have complications from an illness, Medicare won’t cover those expenses unless they’re deemed “medically necessary” by your doctor. However, if your doctor says surgery is medically necessary and the hospital bills it, Medicare will pay for it.
Medicare doesn’t cover:
• Physical therapy after knee replacement surgery because they consider it cosmetic
• Medical transportation services (like taxis)
• Chiropractor services because they consider preventive care
What You Need to Enroll for Medicare
To enroll in Medicare, you’ll need to visit your local Social Security office with your birth certificate, proof of your age, proof of disability, and any other documents required to verify your identity. You will also need to pay a premium for Medicare coverage. The premium is based on your income and family size.
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