- You
use your red, white, and blue Medicare card when you get
health care.
- You
can go to any doctor, supplier, hospital, or other facility
that accepts Medicare and is accepting new Medicare patients.
- You
may have supplemental coverage, such as a Medicare
Supplement (also known as a Medigap policy) or a Medicare
Advantage plan that may pay costs that the Original
Medicare Plan doesn’t.
- You
can purchase Medicare Supplements from private insurance
carriers, and pay a monthly premium, while Medicare Advantage
plans have higher deductibles, are funded by the government,
and often come with no monthly premium. In exchange
for accepting a higher deductible, you receive a Medical
Savings Account, also funded with government contributions
that you can use to pay for your qualified medical expenses.
The
Different Parts of Medicare
You
can get the most from your Medicare benefits by learning what
Medicare covers and by taking advantage of all that Medicare
has to offer.
Medicare
has the following parts:
Medicare
Part A (Hospital Insurance) helps cover your inpatient
care in hospitals. Part A also helps cover skilled
nursing facility, hospice, and home health care if you meet
certain conditions.
Medicare
Part B (Medical Insurance) helps cover medically-necessary
services like doctors' services and outpatient care.
Part B also helps cover some preventive services to help
maintain your health and to keep certain illnesses from
getting worse. There is a $135 deductible, then Medicare
pays its share (usually 80%), and you pay your share (coinsurance
or co-payment—usually 20%) for Part B-covered services
and supplies.
Medicare
Part C (Medicare Advantage Plans) is another way to
get your Medicare benefits. It combines Part A, Part
B, and, sometimes, Part D (prescription drug) coverage.
Medicare Advantage Plans are managed by private insurance
companies approved by Medicare. These plans must cover
medically-necessary services. However, plans can charge
different copayments, coinsurance, or deductibles for these
services.
Medicare
Part D (Medicare Prescription Drug Coverage) helps cover
prescription drugs. This coverage may help lower your
prescription drug costs and help protect against higher
costs in the future.
What Services Does Medicare Cover?
Medicare
covers certain medical services and supplies in hospitals, doctors' offices, and
other health care settings. Services are either covered under Medicare Part
A (Hospital Insurance) or Medicare Part B (Medical Insurance). If you have
both Part A and Part B, these services and supplies must be covered as long as
they are reasonable and necessary for your health, no matter what type of Medicare
plan you have. What
Is Part A (Hospital Insurance)? Part
A helps cover the following after a $1068 deductible: Inpatient
care in hospitals - this includes critical access hospitals and inpatient rehabilitation
facilities, inpatient stays in a skilled nursing facility (not custodial or long-term
care), hospice care services, home health care services, and inpatient care in
a Religious Nonmedical Health Care Institution (coverage is related to non-medical,
non-religious parts of care). You
usually don't pay a monthly premium for Part A coverage if you or your spouse
paid Medicare taxes while working. If you aren't eligible for premium-free
Part A, you may be able to buy it if you meet one of these conditions:
- You didn't work or didn't
pay enough Medicare taxes while you worked and you are age 65 or older
- You
are disabled and have returned to work
Note:
The 2009 Part A premium amount for people who must buy Part A is up to $423 each
month. In most cases, if you choose to buy Part A, you must also have or
enroll in Part B and pay the monthly Part B premium. If you have limited
income and resources, your state may help you pay for Part A and/or Part B When
Can You Sign Up for Part A? If
you get benefits from Social Security or the Railroad Retirement Board (RRB),
you will automatically get Part A starting the first day of the month you turn
age 65. If you are under age 65 and disabled, you will automatically get
Part A after you get disability benefits from Social Security or RRB for 24 months.
Your Medicare card will be mailed to you about 3 months before your 65th birthday,
or your 25th month of disability benefits. People with ALS (Amyotrophic
Lateral Sclerosis, or Lou Gehrig's disease) automatically get Part A the month
their disability benefits begin. If you aren't eligible for premium-free
Part A, you can buy Part A during the following times: - Initial
Enrollment Period - the 7-month period that begins 3 months before your 65th
birthday and ends 3 months after your 65th birthday.
- General
Enrollment Period - from January 1 - March 31 each year
- Special
Enrollment Period - if you have group health coverage through your or your
spouse’s employer or union, you may have a special enrollment period.
Part
A-Covered Services Hospital Stays Semi-private
room, meals, general nursing, drugs as part of your inpatient treatment, and other
hospital services and supplies. This includes inpatient care you get in
acute care hospitals, critical access hospitals, inpatient care as part of a clinical
research study, and mental health care. This doesn't include private-duty
nursing or a television or telephone in your room. It also doesn't include
a private room, unless medically necessary. Inpatient mental health care
in a psychiatric hospital is limited to 190 days in a lifetime. Blood Starting
with the 4th pint of blood you get at a hospital or skilled nursing facility during
a covered stay. The first three pints are not covered. Home
Health Services Limited
to reasonable and necessary part-time or intermittent skilled care or continuing
need for physical therapy, occupational therapy, or speech-related pathology ordered
by the doctor and provided by Medicare-certified home health agency. Home
health services may also include medical social services, home health aide services
or other services, durable medical equipment (such as wheelchairs, hospital beds,
oxygen, and walkers), and medical supplies for use at home. Hospice
Care For
people with a terminal illness who are expected to live 6 months or less if the
disease runs its normal course. Coverage includes drugs, medical and support
services from a Medicare-approved hospice, and other services not otherwise covered
by Medicare (like grief counseling) for terminal and related conditions.
Hospice care is usually given in your home (or other facility where you may live).
Medicare covers some short-term inpatient stays (for pain and symptom management)
and inpatient respite care (care given to a hospice patient so that the usual
caregiver can rest). Skilled
Nursing Facility Care Semi-private
room, meals, skilled nursing and rehabilitative services, and other services and
supplies (only after a 3-day minimum inpatient hospital stay for a related illness
or injury) for up to 100 days in a benefit period. To get care in a skilled
nursing facility, you must need skilled care like intravenous injections or physical
therapy. Medicare does not cover long-term care or custodial care in this
setting. What
Is Part B (Medical Insurance)? Part
B helps cover medically-necessary services like doctors' services, outpatient
care, and other medical services that Part A doesn't cover. Part B also
covers some preventive services. If you aren't sure if you have Part B, look at
your Medicare card. If you have Part B, "MEDICAL (PART B)" is
printed on your card. How
Much Does Part B Cost? You
pay the Part B premium each month. Most people will pay the standard premium
amount, which is $96.40 in 2009. However, your monthly premium will be higher
if you are single (file an individual tax return) and your yearly income is more
than $82,000, or if you are married (file a joint tax return) and your yearly
income is more than $164,000. See the chart below. You also pay a
Part B deductible each year before Medicare starts to pay its share. In 2009,
the deductible amount is $135. When
Can You Sign Up for Part B? If
you get benefits from Social Security or the Railroad Retirement Board (RRB),
you will automatically get Part B starting the first day of the month you turn
age 65. If you are under age 65 and disabled, you will automatically get
Part B after you get disability benefits from Social Security or RRB for 24 months.
You will get your Medicare card in the mail about 3 months before your 65th birthday
or your 25th month of disability benefits. If you don't want Part B, follow
the instructions that come with the card, and send the card back. If you
keep the card, you keep Part B. People with ALS (Amyotrophic Lateral Sclerosis,
or Lou Gehrig's disease) automatically get Part B the month their disability benefits
begin. If you aren't getting Social Security or RRB benefits, and you want
to get Part B, you will need to sign up for Part B when you are close to age 65.
If you didn't sign up for Part B when you first became eligible, you may be able
to sign up during one of these times: General
Enrollment Period The
General Enrollment Period is from January 1-March 31 each year. Your coverage
will begin on July 1. However, the cost of your Part B will go up 10% for
each full 12-month period you could have had Part B but didn't sign up for it,
unless you qualify for a Special Enrollment Period (see below). You may
have to pay this late-enrollment penalty as long as you have Part Special
Enrollment Period
If you wait to sign up for Part B because you or your spouse are working and have
group health plan coverage based on that work or if you are disabled and you or
a family member are working and have group health plan coverage based on that
work. You can sign up for Part B any time while you have group health plan
coverage based on current employment or during the 8-month period that begins
the month the employment ends, or the group health plan coverage ends, whichever
happens first. Special
Enrollment Period for International Volunteers If
you waited to enroll in Part B because you had health insurance while volunteering
in a foreign country. Usually, you don't pay a late-enrollment penalty to
sign up for Part B during a Special Enrollment Period. What
Is the Part B Late-Enrollment Penalty? If
you don't sign up for Part B when you are first eligible, the cost for Part B
may go up 10% for each full 12-month period that you could have had Part B, but
didn't sign up for it. If you delay taking Part B because you or your spouse
(or a family member, if you are disabled) are working and have group health plan
coverage based on that work, you may not have to pay the higher premium. Part
B Helps Cover the Following: Medically-necessary
services - this means the item or service is needed for the diagnosis or treatment
of your medical condition. Preventive
services - Services that help prevent or lessen complications from a condition
you already have, find health problems early when treatment works best, or manage
a medical problem. What
You Pay for Medicare Part B-Covered Services Costs
for Part B services vary depending on the type of service you get and the type
of plan you choose. General cost information is provided in the Part B coverage
charts for the Original Medicare Plan below. This information may help you
understand the coverage charts: "No
cost" means that Medicare will pay for the service, and there is no cost
to you. "You pay coinsurance" means that, in most cases, you will pay
20% of the Medicare-approved amount for the service. "You pay coinsurance
and Part B deductible applies" means that you must pay all costs until you
meet the yearly Part B deductible before Medicare begins to pay its share. See
page 112 for the Part B deductible amount. Then, you pay the coinsurance (in most
cases, 20% of the Medicare-approved amount of the service). PART
B - COVERED SERVICES: | 
