Original Medicare
There are three different ways to qualify for Medicare: being 65 or older, having received disability benefits for 24 months or longer, or if you have end-stage renal disease (ESRD). Medicare is split into 4 main parts and these are some of the things they cover:
Part A: Hospital
- Inpatient care in a hospital
- Skilled nursing facility care
- Nursing home care
- Part-Time Home Care
- Hospice for the Terminally Ill
Part B: Medical
- Outpatient Services
- Ambulance Services
- Outpatient physical, speech, and occupational therapy
- Outpatient Surgeries
- Durable Medical Equipment
- X-Rays
Medicare Part A: Hospital Insurance
Medicare Part A helps cover your inpatient care in hospitals, critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Most people who are eligible for Medicare, do not pay a Part A premium. Part A pays 100% of allowable charges for the first 60 days after you meet your Part A deductible. The Part A deductible for 2023 is $1100 for day 1-60, and $275/day61-90, and $550 for 90-150, and after 150 days you would be responsible for 100% of hospital costs
Medicare Part B: Medical Insurance
Medicare Part B helps cover medical services like doctor’s services, outpatient care, and other medical services that Part A doesn’t cover. Part B is optional. Part B helps pay for covered medical services and items when they are medically necessary. Part B does have a monthly premium to the federal government. Part B will pay 80% of the Medicare approved amounts once the Part B deductible has been met. The deductible for 2023 is $233 – in addition you would be responsible for 20% of Medicare allowable costs if you do not have a Medigap plan.
Part B covers 2 types of services
Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
Preventative Services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.
Part B covers things like (click links below for information from Medicare.gov):
Part C Medicare Advantage
This combines the benefits for both Part A and Part B, and offers additional benefits such as:
- Prescription Drug Coverage
- Dental, Vision, and Hearing Services
- Health and Wellness Programs
- Private Health Insurance Companies always administer but Federal Government overseen.
Part D Prescription Drug Coverage
- Covers Prescription Drugs
- Must have Medicare Part A AND/OR Part B to enroll
- Offered by Private Companies; however guidelines and coverage overseen by the Federal Government
- Each Part D plan decides which specific drugs it will cover and what plan members will pay but must be approved by the Federal Government