Different parts of Medicare cover specific services. Generally, most beneficiaries choose to receive Medicare Part A and Medicare Part B coverage through Original Medicare. Original Medicare is the traditional fee-for-service program offered directly by the federal government.
The government pays directly for health care services under Original Medicare. With this coverage, you can see any doctor and hospital that takes Medicare anywhere in the country.
Refer to your explanation of benefits/summary of benefits for the specific doctors and hospitals covered under your Medicare benefits.
With Original Medicare:
Note: You may be able to help reduce your health care and prescription drug plan costs if you meet certain eligibility requirements.
If you have a low monthly income and a few assets, you may be eligible to receive Medicaid, on top of your Original Medicare benefits.
Medicaid can help pay for costs like copayments, and deductibles and cover healthcare not covered by Medicare, such as dental care and transportation to medical appointments.
The Medicare Savings Program helps you pay off Medicare costs. If you have a low monthly income, you may qualify for this program.
Instead of Original Medicare, you can decide to get your Medicare benefits from a Medicare Advantage Plan, also called Medicare Part C or Medicare through private insurance companies. You will still have Medicare if you enroll in a Medicare Advantage Plan.
You must still pay your monthly Part B premium (and Part A premium if you have one.)
This federal program helps individuals with low-income pay for the costs of Medicare prescription drug coverage. If you are enrolled in Medicaid, an MSP, or receive Supplemental Security Income (SSI), you should automatically get Extra Help.
Apply for this program via the Social Security Administration or contact your local Medicaid office. Understanding your Medicare coverage choices and knowing how to pick coverage is crucial.
How you choose your benefits and where you get them from can affect your out-of-pocket costs.
For instance, with Original Medicare, you are covered to go to nearly all doctors and hospitals in the country. On the other hand, Medicare Advantage plans typically have network restrictions, meaning there will likely be more restrictions and a more limited choice of doctors.
Medicare Advantage also provides additional benefits that Original Medicare does not cover, for instance, routine vision or dental care.
Medicare Part A (hospital coverage) covers things like inpatient hospital stays, nursing homes, home health care, hospice care, and some skilled nursing facilities.
Typically most people don’t pay for Medicare Part A, however, some may pay a premium for these benefits. If you paid Medicare taxes for a certain amount of time while working you don’t pay.
If you do not qualify for premium-free Medicare Part A, it can be purchased for a monthly premium. Keep in mind, this amount can change each year and is based on how long you or your spouse worked and paid Medicare taxes.
Medicare Part B (medical coverage) covers doctor visits, outpatient services, X-rays, lab tests, medical equipment, mental health, and preventive services.
If you have health insurance through a current job or are on your spouse’s active insurance plan, you can delay your Medicare Part B enrollment without penalty.
Once you or the spouse with employer coverage stops working, you have eight months to sign up for Medicare Part B. You also need to be enrolled in a Medicare Part B plan if you want to sign up for Medicare Advantage.
Medicare Part C (Medicare Advantage) is offered through private insurance companies.
When joining Medicare Advantage, you still have Medicare. The difference is this plan covers and pays for your services instead of your Original Medicare plan. The services provided on this plan must provide the same coverage as the Original Medicare. Medicare Advantage plans also offer extra benefits.
Plans offered through a private insurance company cover everything Original Medicare does and usually include more coverage for services you might need down the line.
Medicare Advantage plans can include extra benefits and parks, such as gym memberships or discounts.
Medicare Part D (prescription drug coverage) is only offered through private insurance companies. It is usually offered through a Medicare Advantage plan or you can purchase a separate Medicare Part D plan.
Medicare Part D provides a wide range of coverage for vaccines and outpatient prescription drugs.
There are common services that Medicare does and doesn’t cover. Visit medicare.gov/coverage for further detail.
Also, check your Medicare health plan’s Summary of Benefits to learn what’s covered.
Medicare has some coverage for acupuncture services however, it is limited to the treatment of chronic lower back pain.
Some Medicare Advantage plans have benefits that help pay for acupuncture services, such as chronic pain in other parts of the body, headaches, and nausea.
Medicare Part A may cover care in a skilled nursing facility if it’s deemed medically necessary. This is usually a short-term visit for recovery from an illness or injury.
Medicare Part B covers outpatient surgery to correct cataracts.
Medicare Part B covers chiropractors’ manual alignments of the spine. However, Medicare doesn’t cover other chiropractic tests or services like X-rays, massage therapy, or acupuncture.
Medicare generally doesn’t cover these services, however, Medicare Part B does pay for eyeglasses or contact lenses if needed after cataract surgery.
Both Medicare Part A and Medicare Part B cover some home health services if you meet certain conditions.
These services include:
For more information on the different parts of Medicare, Covered Services, Covered Providers, and Covered Hospitals visit medicare.gov.
Shelia Benson was born and raised in Las Vegas, Nevada. She comes from a family of insurance professionals and has 12 years of experience in the insurance industry as a licensed agent and is also certified in Medicare. It's her passion to be of service to consumers turning 65 or coming onto Medicare for the first time. During her free time, she loves to spend time with her family and her dog, working out, hiking, trying out new restaurants, and going to concerts. Shelia's goal is to educate the Medicare-eligible about how Medicare works.
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