How Does Medicare Work?
Original Medicare is the federally administered health care program for adults over 65. You may also be eligible at any age if you qualify through disability or have certain conditions.
Medicare is broken into four parts; A, B, C and D.
Part A - Hospital stays and skilled nursing after a hospital stay. It also assists with some home-bound skilled care and hospice care.
- You can choose any qualified provider in the USA who accepts new Medicare patients.
- Some coverage limits apply – if you are hospitalized or are in a skilled nursing facility for more than 90 days, you may have to pay for part of the costs.
- Doctor services in the hospital are not covered under Part A.
- You will not pay a premium for Part A if you or your spouse have contributed to Social Security for at least 10 years.
Your share of the costs will include:
- A deductible – that is determined each year.
- A copay – after staying a certain number of days you are liable for copays. These increase for extended stays.
- Coinsurance – applies to inpatient respite care for hospice patients.
Consider adding Medicare Supplement Insurance to cover Part A and B out-of-pocket expenses – a PMB Senior Services expert can help you with these choices.
Part B - Covers the costs of medically necessary doctor visits and medical services such as outpatient care at hospitals and clinics, laboratory tests, certain diagnostic screenings, and some skilled nursing care.
- You can choose any qualified provider in the USA who accepts new Medicare patients.
- Some coverage limits apply – limits on occupational therapy, and limits on screenings are covered only for specific times.
- Vision, dental and hearing is only covered under certain situations under Part B.
- Part B does not cover care outside the USA.
- Your Part B premium is dependent on your yearly income. Most people pay a monthly premium.
- If you receive Social Security, premiums will be automatically deducted from your benefits.
Your share of the costs will include the deductible, copays and coinsurance.
Consider adding Medicare Supplement Insurance to cover Part A and B out-of-pocket expenses.
Part C - Medicare Advantage plans (Part C) are run by private insurance companies. These plans combine coverage for certain hospital costs, doctors visits and other medical services – they may also include prescription drug coverage..
- All covered under one plan.
- Dependent on the plan, you can choose a primary care doctor or you can visit a provider who accepts the plan’s terms, conditions and rates.
- Part C plans have appointed service areas and nationwide emergency coverage.
- Coverage limits vary according to different plans.
- Part C plans cover the same services as Part A and B except for hospice care under Part A.
Your share of the costs:
- Plan premiums vary widely.
- Plan details will tell you if they have deductibles or not. Many do charge copays or coinsurance.
- For prescription drugs, you may be subject to a coverage gap.
Part D - Plans to help you pay for prescription drugs – these plans are optional. If you don’t sign up when you become eligible, you may be subject to a higher premium later when you do enroll.
- These plans are sold by private companies.
- The government set the guidelines and the plans offer different drug lists and costs.
- The Part D plan details will inform you what pharmacies you can use and limitations which may apply. Check to see if your plan offers a mail order service?
- Coverage limits in terms of cost and drugs offered vary widely dependent on the plan.
- Most plans have a coverage gap (donut hole) where you will have to pay some of the costs.
- Premiums for the following year are announced in October. Premiums may vary even though plans offer the same drug coverage – get an annual free plan checkup from Premier Medicare Benefits!
How does Medicare work – PMB SENIOR SERVICES.