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Many people are confused by Medicare health coverage. There is so much information to absorb and rules to follow.
Did you know that 15 percent of America’s population uses Medicare? There are currently 44 million Americans on Medicare with that figure expected to rise to 79 million in the next 12 years.
The message here is that many Americans effectively use Medicare each day and you can too. Read on for a guide to understanding Medicare coverage. Explore the different types of Medicare coverage and important rules that govern the process.
What Are the Basics for Understanding Medicare?
The vast majority of people have been paying into Medicare for their entire working life. Medicare is funded by payroll taxes that are automatically deducted from your paycheck.
Medicare is not a free benefit that the Government provides to you. This is a benefit that you have earned and been paying into for decades. Depending on your income level, additional monthly premiums may be required.
Only American citizens are eligible for Medicare coverage. Permanent legal residents that have lived in the United States for 5 years or more may be eligible as well.
The first thing you need to know is that Medicare health coverage kicks in at age 65. When you turn 65, take a trip to your local Social Security office.
Start off by enrolling in Medicare Part A and Part B. The Social Security office will provide you with a Medicare insurance card. If you sign up for other Medicare plans, additional insurance cards will be provided to you.
Medicare Part A
There are many different Medicare plans and they are broken out by “parts.” Part A is one of two basic plans that are provided to all enrollees.
Part A provides insurance coverage for hospital visits. For starters, Part A covers room and board when you are admitted to the hospital.
This includes all services and supplies that are provided by the hospital staff. The term hospital is broad and includes many different care facilities. Examples of a hospital falling under Medicare Part A are rehabilitation and mental health facilities, long-term care, and acute care hospitals.
Stays at a skilled nursing facility are also covered under Part A. Another item covered by Medicare Part A is hospice care. Lastly, there is limited coverage for home services.
Medicare Part B
Part B provides coverage for the remainder of your medical needs. This Medicare type covers your visits to a primary care physician or a specialist.
There are two types of services that Medicare Part B generally covers. The first is health care deemed to be preventative in nature.
This is medical care that is designed to prevent medical issues from occurring in the first place. A few examples of preventative services are a flu shot or an annual physical.
There is a chance that you make zero payment for preventative services. This happens when a doctor agrees to be paid by Medicare.
In addition, the doctor must accept the full payment amount that the Government sets for the service. If the doctor accepts the Medicare payment as full, this means there should be no copayment or coinsurance for the service.
Before you start using Medicare, it is recommended to reach out to your doctors. First, make sure they accept Medicare and then ask if they consider preventative services payments to cover 100 percent of the bill.
The second type of service that Medicare Part B covers is medically necessary services. These are the services that a doctor or medical provider prescribes to diagnose or treat a condition.
For example, consider that you have a pain in your abdomen and see a urologist. The urologist runs a series of tests including a colonoscopy. Your visit to a specialist and diagnostic tests would be covered under Medicare Part B.
Medicare Part D
Part D is a fairly recent addition to the Medicare program. It was added in 2003 by former President Bush and covers prescription drugs.
Medicare Part D is different than Parts A and B because the government works with private insurance companies to deliver the coverage. If you are receiving all of your medical coverage through Parts A and B, then you will get a standalone prescription drug plan.
The government provides a list of private insurance companies that meet Medicare’s requirement for drug coverage. Depending on your income, there may be a monthly premium for coverage. This comes in the form of a surcharge that is paid directly to Medicare.
There are different prescription drug plans with different types of coverage. Some Medicare advice for you is to shop around and find the best prescription drug plan for your family.
There cannot be a guide to Medicare without a discussion on Medigap plans. Unfortunately, basic Medicare plans do not cover everything. Without additional coverage, the patient is required to pay the difference between the billed amount and what Medicare pays.
To alleviate this burden, many people choose to purchase Medigap plans. They are offered by private insurance companies and have a designated Medicare Part.
For example, Medicare Part F or Part J is simply a Medigap plan. Each part designation has different coverages, but in general, they cover deductibles and coinsurance that are left over from basic Medicare coverage. To learn more about Medigap plans, check out https://www.medigap.com/medicare-plans/ for more information.
Understanding Medicare includes learning about Advantage plans. They are typically given the designation of Medicare Part C.
Essentially, they roll all of the Medicare coverages into one umbrella plan. In addition, they usually offer additional coverage for vision and dental.
Medicare Advantage plans are offered by private insurance companies. These companies receive a payment from Medicare for your basic coverage. You are responsible to pay for the additional coverages through a monthly premium.
Wrapping It Up
There are so many different Medicare plans and it can get confusing. The good news is that the government provides medical coverage to all eligible Americans aged 65 or over.
If you want additional coverage, you can elect to purchase a Medigap or Medicare Advantage plan for a monthly fee. If you enjoyed this article about understanding Medicare, please check out our website for other great pieces.