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Primary information about Medicare

Primary information about Medicare

What is the meaning of Medicare? Do you have the necessary eligibilities for it? Go to this page if you want to know about the basics. It includes details about the various aspects of Medicare and the kind of coverage provided by them. If you know nothing about Medicare, this is the page to start with.

You are entitled to enrollment in Medicare health insurance programme if (a) you are over 65 (b) under 65 years of age and disabled or (c) you have renal disease that is in the last stages.

Basically, there are 3 parts of Medicare.

  • Part A- hospital insurance. A part of your income is set aside while you are working. This becomes the premium later on. As a result, you don’t have to pay separately for this coverage.
  • Part B- this is medical insurance. There is a monthly charge as premium for this coverage.
  • Part D- This is coverage for prescription drugs. There is a premium you have to pay if you are enrolling for Medicare.

With time, the number of plans offered by Medicare has gone up. Now, in addition to the original Medicare Plan, you also have the Medicare Advantage Plans. These include PPO, Medicare Special Needs Plans and HMOs, Medicare Private Fee for Service Plans, Medicare Prescription Drug Plans and Medicare Cost Plans.

Certain common services and items are also covered by Medicare. These include clinical trials, ambulance services, diabetic self management techniques and chiropractic services. Emergency room services, foot exams with treatment are also covered. Hearing exams, long term care, mental health care, medical nutrition services and prosthetics are also covered. Counseling for cessation of smoking, second opinions on surgical, dressings and telemedicine in certain rural areas are also covered. MRIs, CT scans and Test X rays are also covered. EKGs are also covered if they are medically necessary.

Medicare Part A

This includes the hospital insurance portion of Original Medicare. Usually, if you eligible for Medicare A, you don’t have to pay for Part A. if you are eligible for coverage but have not contributed enough through payroll deductions, you have to pay a fixed premium every month. The amount is determined by the number of years the person or his/her spouse has worked in the US. Usually, if you are over 65, you are automatically included under Medicare. You will receive a Medicare ID card and information about three months before you reach 65 if you are registered with the Social Security Administration.

Medicare part A helps pay for inpatient medical care in a hospital, hospice care, skilled nursing care and home health care to a limited extent. To avail of inpatient hospital covers, you have to first pay certain deductibles in a benefit period. If you are having a prolonged stay at a hospital, you must pay a certain percentage of coinsurance. As of 2007, the deductible for inpatient hospital care is $992 in a certain benefit period. You don’t have to pay any coinsurance for the first 60 days you are hospitalized. For the 61st to 90th day of hospitalization, you pay a coinsurance of $248 a day. It goes up to $496 after 90 days of hospitalization. There is also no coinsurance for the first 20 days. After that the coinsurance rate goes up to $124 a day till 100 days. Medicare Part A does not pay for office visits, ambulance services, outpatient care and lab/radiology services. These benefits are covered under the Medicare Part B program.

Medicare Part B

Medicare Part B is the portion of Original Medicare dealing with medical services. Before you enroll for Medicare, you are given an option to enroll in Part B of Medicare. You pay a separate deductible for this facility. The premium is $88.50 for a person per month. There may be a penalty charge if you do not avail of Plan B when it is first offered to you. This may increase the premiums per month. From 2007 onwards, the premiums are based on the income of the applicant. It is best to contact your state insurance department for updated details.

Medicare part B provides coverage for medical services and items that are considered ‘medically necessary ‘or are part of the preventive services covered by Medicare. Preventive healthcare may include medical exams, screening shots and lab work. Medicare also includes other advantages like coverage for ambulance services, bone mass and blood measurement and ambulatory surgery centers. It also includes cardiovascular screenings, limited chiropractic services, clinical trials, diabetes screenings, clinical laboratory services, colorectal cancer screenings and self management training. Diabetic supplies, durable medical equipment, doctor services, limited eyeglass benefits, flu shots, glaucoma testing, foot exams and treatment, hearing and balance treatments, home health services, Hepatitis B shots, kidney dialysis services, medical nutrition, mammograms, occupational therapy, mental health care, outpatient surgical and hospital services, pelvic exams and pap smears, practitioner services, physical therapy, prosthetics, smoking cessation programs, urgent care, second medical opinions and transplant services.

Some of the services covered under Medicare require payments of a coinsurance or deductible. Prescription drug coverage, apart from particular injectible drugs for cancer, is not provided under Part B. this coverage is offered under Medicare Part D.

Not included in covers under Part A or Part B.

You may receive coverage for some of these services if you join one of the plans that are offered. You can also find out about the coverage of these procedures from Medicare supplemental insurance policy.

Dental care, dentures, custodial care, acupuncture, cosmetic surgery, eye refractions, hearing tests, hearing aids and hearing tests prescribed by a person other than your doctor, special shoes, long term care and certain diabetic supplies are not covered.

Medicare part D

It is a new prescription drug coverage that is available to you as an option. It allows persons eligible for Medicare to add prescription coverage for payment of a monthly premium. You can get these plans from private carriers approved by Medicare. The type of cover you opt for decides your monthly premiums. You may also need to pay deductibles and coinsurance based on the plan you choose. These plans have contracts with particular pharmacies and fixed lists of drugs covered called formularies. To ensure that your location and medical needs are met, try to know which drugs and pharmacists are covered by your plan.

The annual deductible for Medicare Part D is $265. This indicates that each year you have to pay the first $265 of your bills. After this, Medicare begins payment. Medicare covers up to $2400 of your costs in a year. If your costs are between $2400 and $3850 in a year, you have to pay 100% of the costs. This is called the Medicare Part D ‘doughnut hole’. If your costs are over $3850, you may get a coinsurance of 5%, generic drug payment of $2.15 or $5.35. For people with low incomes, coinsurance and premium assistance is also provided. Medicare supplemental and Medicare advantage may also provide separate covers for prescription drugs. It is always best to verify current details with your state insurance department.

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