Medicare can be confusing. Let's cover some of the basics.
In the United States, Medicare is a health-insurance program for anyone over 65. Medicare may be available to those under the age of 65 who have disabilities or have irreversible renal failure.
Although the program helps with healthcare expenditures, it does not cover all medical bills or most long-term care expenses. You may get Medicare coverage in a few different ways. If you choose to have Original Medicare (Medicare Part A and Part B) coverage, you can purchase a Medicare Supplement Insurance (Medigap) policy from a commercial insurance carrier.
What are the parts of Medicare?
The various elements of Medicare assist in the coverage of certain services:
- Medicare Part A (Hospital Insurance)
- Inpatient hospital stays, skilled nursing facility care, hospice care, and certain home health care are all covered in Medicare Part A.
- Medicare Part B (Medical Insurance)
- Part B covers certain doctor’s services, outpatient care, medical supplies, and preventive services.
- Medicare Part D (prescription drug coverage)
- Assist in covering the cost of prescription medications (including many recommended shots or vaccines).
What is Medicare Part A? Hospital Insurance.
Medicare Part A covers the following services:
- Inpatient hospital care: is provided once a physician has formally admitted you to a hospital. You are covered at a general hospital for up to 90 days every benefit term, plus 60 lifetime reserve days. Medicare also pays up to 190 days in a Medicare-certified mental institution throughout the course of a lifetime.
- Skilled nursing facility (SNF) care: Medicare covers room, board, and a variety of services given at a skilled nursing facility (SNF), such as medication administration, tube feedings, and wound care. If you qualify for coverage, you can be covered for up to 100 days per benefit period. You must have spent at least three consecutive days in the hospital within 30 days of admission to the SNF and require skilled nursing or therapy services to qualify.
- Home health care: If you are homebound and require expert care, Medicare pays for services in your home. You’re covered for up to 100 days of continuous care or an unlimited number of days of intermittent care. You must have spent at least three consecutive days as a hospital inpatient within 14 days of obtaining home health care to be eligible for Part A coverage.
- Hospice care: If a clinician thinks you are terminally ill, you may choose to receive this type of treatment. You are insured for as long as your doctor confirms that you require medical attention.
Keep in mind that Medicare does not always cover the whole cost of your treatment, and you will almost certainly be liable for some cost-sharing (deductibles, coinsurances, and copayments) for Medicare-covered services.
Because they or a spouse have 40 or more quarters of Medicare-covered work, most persons do not have to pay a monthly Part A fee. The Part A premium will be $499 per month in 2022 if a person has less than 30 quarters of Medicare-covered work. The Part A cost is $274 per month if a person has 30 to 39 quarters of Medicare-covered work.
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What is Medicare Part B? Medical Insurance.
Outpatient/Medical insurance coverage is provided through Medicare Part B. Part B-covered services and coverage rules are summarised in the table below:
- Provider services: Services provided by a registered health practitioner that are medically required.
- Durable medical equipment (DME): This is medical equipment that can survive repeated usage and is suitable for use in the home. Walkers, wheelchairs, and oxygen tanks are just a few examples. After your clinician confirms your need for DME, you can buy or rent it from a Medicare-approved source. Durable Medical Equipment
- Home health treatments are covered if you are confined to your home and require expert nursing or therapy.
- Ambulance services: This is a type of emergency transportation that is used to get people to and from hospitals. Non-emergency ambulance/ambulette transportation is only covered in cases when there is no other safe mode of transportation and the transportation is medically essential.
- Preventive services: These are tests and consultations designed to help you avoid disease, diagnose issues, and stay healthy. Preventive treatment is usually covered by Medicare with no coinsurance.
- Therapy services: A Medicare-certified therapist provides outpatient physical, speech, and occupational therapy services.
- Mental health services.
- X-rays and lab tests.
- Chiropractic therapy is used when spinal manipulation is medically essential to correct a subluxation (when one or more of the bones of the spine move out of position).
- Immunosuppressant medications, certain anti-cancer treatments, some anti-emetic drugs, some dialysis drugs, and pharmaceuticals that are normally delivered by a physician are all examples of prescription drugs.
This list covers some of the most regularly covered services and commodities, although it is not exhaustive. Keep in mind that Medicare does not always cover the whole cost of your treatment, and you will almost certainly be liable for some cost-sharing (deductibles, coinsurances, and copayments) for Medicare-covered services.
The Part-B premium for 2022 is $170.10 per month (premiums for people with annual earnings of $91,000 or more and married couples with annual incomes of $182,000 or more will be higher).
For information on Medicare Part A and B premiums, deductibles, and co-insurances, go to the Medicare Part A and B Premiums, Deductibles, and Co-Insurances page.
Medicare Part A & Part B Premiums
The majority of consumers do not pay a monthly Part A premium.
If you or your spouse paid Medicare taxes while working for a set period of time, you normally don’t have to pay a monthly premium for Part A. This is referred to as “premium-free Part A” on occasion.
What is covered by Medicare Part A in details
Hospitalizations and inpatient treatment, such as:
A room that is semi-private
Meals at the hospital
Nursing services provided by professionals
Specialized treatment, such as critical care, is available.
During an inpatient stay, drugs, medical supplies, and medical equipment are used.
As an inpatient, lab tests, X-rays, and medical equipment are used.
Services in the operating room and the recovery room
Services in the operating room and the recovery room
In a hospital or skilled care facility, certain blood transfusions are required.
After an approved hospital stay, inpatient or outpatient rehabilitation options are available.
Part-time, expert care for those who are unable to leave their homes
What is not covered by Medicare Part B
Exams, glasses, or contact lenses are all options.
Hearing exams or hearing aids are both options.
Exams, cleanings, X-rays, and other dental procedures are all part of basic dental care.
The majority of prescribed medications
Long-term assistance (also called custodial care)
Cosmetic surgery is a procedure that is used to improve
Foot care that is done on a regular basis
What is Medicare Part C? Medicare Advantage Plans.
Medicare Advantage Plans must provide at least the same benefits as Original Medicare (Parts A and B), but they are limited in their ability to do so due to various regulations, pricing, and coverage limits. Part D is usually included in your Medicare Advantage coverage package (MAPD). There is a variety of Medicare Advantage Plans to choose from. In addition to your Part B payment, you may have to pay a monthly premium for this coverage.
If you join in a Medicare Advantage Plan, you won’t be able to use your red, white, and blue Medicare card when visiting the doctor or the hospital. Instead, you’ll use the membership card provided by your private plan to get health care coverage. you can also use this card at the drugstore (Part D), if your health plan has Medicare prescription drug coverage (Part D).
What is Medicare Part D? Prescription Drug Coverage.
The outpatient drug benefit (Section D) of Medicare is part of the program that covers prescription drugs. Part D is only available through private insurance firms that have contracts with the federal government; the government never provides it directly (unlike Original Medicare).
You must enroll in a private Medicare prescription drug plan (PDP) or a Medicare Advantage Plan with drug coverage if you desire Part D coverage (MAPD). Enrollment is voluntary (but encouraged to prevent future fines) and only available during certain enrollment times. When you initially become eligible for Medicare, you should usually enroll in Part D.
It is up to you to decide whether or not you should enroll in a Medicare Part D plan. Employer or retiree insurance may provide adequate medication coverage. If that’s the case, you won’t need to enroll in a PDP until your current coverage expires. Additionally, certain persons who are already enrolled in certain low-income assistance programs may be automatically enrolled in a Medicare prescription plan and receive additional financial support with the cost of their medications.
What is a Medicare Supplement Plan?
Medicare Supplement Plans are health insurance policies that act in conjunction with Original Medicare and provide specified benefits (not with Medicare Advantage). Private insurance firms are the ones who sell them. After Original Medicare pays initially, a supplement plan pays some or all of specified remaining expenditures. These plans may cover unpaid deductibles, coinsurance, and copayments, as well as health-care expenditures not covered by Medicare, such as treatment received when traveling overseas. Remember that Medicare Supplement Plans may only be used in conjunction with Original Medicare. A Medicare Supplement Plan cannot be purchased if you have a Medicare Advantage Plan.
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Special Enrollment Period (SEP)
You may not need to enroll for Medicare Part B at age 65 if you have medical insurance via your or your spouse’s current employer’s group health plan. You may be eligible for a “Special Enrollment Period” (SEP) during which you can sign up for Part B:
- You or your spouse can continue to be covered under the group health plan at any time during the month.
- The 8-month term begins the month following the conclusion of your group health plan coverage or the job on which it is based, whichever occurs first.
How to Apply for Medicare Online
If you are within three months of turning 65 and are not yet ready to begin receiving monthly Social Security payments, you can use our online retirement application to enroll in Medicare alone and wait to apply for your retirement or spouse’s benefits later. It takes less than 10 minutes, there are no forms to complete, and most paperwork is not necessary.
If you currently receive Social Security benefits:
If you receive Social Security or Railroad Retirement Board payments, you are immediately eligible for Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) on the first day of the month you turn 65. To enlist, you will not need to do anything. About three months before your 65th birthday, you will get your Medicare card in the mail.
If you turn 65 on February 20, 2010, your Medicare coverage will begin on February 1, 2010. (Please note that if your birthday falls on the first day of a month, Medicare Part A and Part B will begin on the first day of the preceding month.) If your 65th birthday falls on February 1, 2010, your Medicare coverage will begin on January 1, 2010.)
If you do not get Social Security payments, you should:
You can apply for retirement benefits online if you are not receiving Social Security payments. If you merely want to file for Medicare, contact 1-800-772-1213 to get started.
If you are handicapped and under the age of 65, you must:
If you’re under 65 and disabled, and you’ve been receiving disability payments from Social Security or the Railroad Retirement Board for at least 24 months, you’ll be eligible for Medicare Part A and Part B on the 25th month of disability benefits. Enrolling in Medicare will not need any action on your part. About 3 months before your Medicare eligibility date, you will get your Medicare card in the mail. (Note: If you have Lou Gehrig’s disease (ALS) and are under the age of 65, you will get Medicare benefits the month you receive disability payments from Social Security or the Railroad Retirement Board.) Call the Social Security Administration at 1-800-772-1213 or go to the Social Security website for further information.