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WHAT DOES MEDICARE COVER

What does  Medicare cover?

Original Medicare is healthcare coverage managed by the federal government.  There are basically only 2 main ways to get your Medicare coverage—through Original Medicare (Part A and Part B) or through a Medicare Advantage Plan (Part C). You will also most likely need to get additional coverage, like a Medicare prescription drug coverage or Medicare Supplement Insurance (Medigap).

 

How Original Medicare works

Original Medicare is coverage managed by the government through the Centers for Medicare and Medicaid Services CMS. Generally, there is a cost for each service that you receive. These are the general rules for how it works:

 

Can I get my health care from any doctor, other health care provider, or hospital?

In most cases, yes. You can go to any medical doctor, hospital, other health care provider, or other facility that’s contracted with Medicare and is accepting new Medicare patients.

 

Are prescription drugs covered in Original Medicare?

Although there are a few exceptions most prescriptions are not covered by Original Medicare. You can add prescription coverage by joining a Medicare Prescription Drug Plan (Part D).

 

Do I need to choose a primary care doctor?

No, not in Original Medicare, you can go see any contracted Medicare doctor you don’t need to choose a primary care doctor.

 

Do I have to get a referral to see a specialist?

Generally not in most cases. With Original Medicare, you don’t need to get a referral, but the specialist must be contracted with Medicare.

 

Should I get a supplemental policy?

Thats a good idea and we recommend that you do so. You may already have an employer or a union coverage that may pay for costs that Original Medicare doesn’t. If not, you should consider buying a Medicare Supplement Insurance (Medigap) policy.

 

What else should I know about Original Medicare?

You basically need to understand that with Original Medicare you pay a set amount for your health care (deductible) before Medicare will pay any of its share. Then, Medicare pays its share, and you pay your share (coinsurance / copayment) for covered services and supplies. There is no yearly limit for what you pay out-of-pocket cost maybe, which is why you should consider additional coverage through a Medicare Supplement Insurance (Medigap) policy. Here are some things for you to know about Original Medicare:

  • You usually pay a monthly premium for Part B.
  • You generally don’t need to file Medicare claims. The law requires providers (like doctors, hospitals, skilled nursing facilities, and home health agencies) and suppliers to file your claims for the covered services and supplies you get.

Major Factors that affect your Original Medicare out-of-pocket costs are

  • Whether you have both Part A and/or Part B. Most people have both.
  • Whether your doctor, other health care provider, or supplier accepts assignment.
  • The type of health care you need and how often you need it.
  • Whether you choose to get services or durable medical supplies Medicare doesn’t cover. If you do, you have to pay all the costs yourself unless you have some other insurance that covers it.
  • Whether you have other health insurance that works along with Medicare.
  • Whether or not you have Medicaid or receive help from your state paying for your Medicare costs.
  • Whether you have a Medicare Supplemental Insurance (Medigap) policy.
  • Whether you and your medical doctor or other health care provider sign a private contract.

So What is Part A (Hospital Insurance)?

You need to know that Part A covers inpatient hospital stays, some home health care, care in a skilled nursing facility and hospice care.

How much does Medicare Part A cost?

How can I get Medicare Part A?

What does Medicare Part A cover?

 

What is Part B (Medical Insurance) and What Does Part B Cover?

Part B covers medical doctors’ services, outpatient care, durable medical equiment supplies, like wheel chairs and oxygen, diabetic medical devices etc , and preventive services.

How much does Medicare Part B cost?

How do you get Medicare Part B?

What does Medicare Part B cover?

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