Medicare Benefits

Medicare is health insurance for those people age 65 or older, under the age of 65 with certain kinds of disabilities, and any age with a condition called End-Stage Renal Disease. Medicare Part A is hospital coverage. Most people automatically get Part A coverage without having to pay a monthly premium because they, or their spouses, paid Medicare taxes while they worked. Part B of Medicare is called the Medical portion of Medicare. Most people pay a monthly premium for their Part B.

The Original Medicare Plan is a medical care plan run by the Federal Government. You are usually charged a fee for each health care service or supply you get. With certain services, you will pay an amount refered to as a deductible before Medicare will pay its share. Then, when you get a Medicare covered medical supply or service, Medicare pays its share, and you pay your share, which is refered to as the coinsurance or a copayment. Original Medicare includes two parts, Part A and Part B. Many people in the Original Medicare plan also get Medicare Supplement Insurance policy from a private insurance company to help pay health care expenses that the Original Medicare Plan doesn't cover.

The Original Medicare Plan is one option available under the Medicare program. You will be in Original Medicare unless you join another Medicare plan. Original Medicare is a fee-for-service plan managed by the Federal Government. Under the Original Medicare program With the Original Medicare system you can go to any doctor, hospital or other facility that is enrolled in the Medicare system. You will pay a set amount for your health care (deductible) before Medicare pays its part. Medicare pays its portion, and you would have to pay your share for covered services and supplies. In order to get prescription medication coverage, you are able to join a Medicare Part D Prescription Drug Plan.

A Medigap policy is a type of health insurance sold by insurance insurance companies to cover "gaps" in Original Medicare Plan coverage. Medicare Supplement plans help to pay your share of the costs of Medicare-covered services, and certain plans will certain expenses not covered by the Original Medicare program. When you are in the Original Medicare sytem and have a Medigap policy, then Medicare and your Medicare Supplement will both pay their shares toward your covered health care costs. Insurance companies can only sell the "standardized" Medigap policies. These "standardized" plans must all have specific benefits. In order to get a Medigap policy you must be in the Original Medicare system.

Part A of Medicare helps to pay for your hospital inpatient costs, critical care hospitals, and skilled nursing facilities. Part A of Medicare does not cover custodial care which is often called long-term care. Part A of Medicare also helps pay for hospice care and limited home health care. Most people do not have to pay a monthly payment, called a premium, for Part A of Medicare. This is because they or a spouse paid taxes for Medicare taxes while they worked. For people who did not pay taxes into Medicare while working and are age 65 or older, they may be able to buy Medicare Part A.

Medicare Part B helps to cover medical services such as physician costs, outpatient costs, and certain other medical expenses that Part A doesn't cover. Part B is optional. Part B helps to pay covered medical services and items when they are medically necessary. It also covers some preventive costs like exams, lab tests, and screening shots to help prevent, find, or manage a medical problem. Most people will have to pay a premium for Medicare Part B. The premium amount can change each year and people who are in higher income brackets will likely be required to pay more for their Part B premium. It is possible that your monthly premium amount can be higher if you didn't get Part B when you were first eligible to do so.

Medicare prescription drug coverage is available to everybody with Medicare. Like other types of insurance, if you join a plan offering Medicare drug coverage, there is likely to be a cost. The amount of the monthly premium isn't affected by your health status or by how many prescriptions you use or even by what medications you are using. There will also be a copayment for your prescription medications. If you have limited income and limited resources, you may qualify for additional help paying for Medicare prescription medication coverage costs.

Medicare prescription drug plans will offer various benefit designs. Some plans may offer more coverage and additional drugs for a higher premium. If you decide not to get a Medicare prescription plan when you first become eligible, you might pay a monetary penalty if you choose to join at a later time. Even if you don't take a lot of prescription drugs when you first go onto Medicare, you still should consider joining a Medicare prescription drug plan.

As we age, most people will eventually need drugs to treat various conditions that might arise. For most, joining a Medicare drug medication plan when you first become eligible for Medicare coverage means paying the lowest possible monthly premium. If you don't join a prescription drug plan when you are first eligible to do so you will most likely have to wait until November 15 to December 31 of each year to join a plan. If you do not buy a Medicare prescription drug drug plan when you are first eligible to do so and you have a continuous period of 63 days or more without creditable prescription drug coverage, you will probably have to pay a late enrollment penalty if you do decide to join at a later time. Your premium cost will go up at a rate of one percent of the current year's national average premium for every full month you had been eligible to join a plan and didn't.

Medicare assignment is where a health care provider has agreed to accept only the amount Medicare approves for any given service. If the doctor or other health care supplier does not agree to accept Medicare assignment, they are allowed to charge you more than the Medicare-approved amount. There is a limit to what they are allowed to charge you for most services. The highest amount you can be charged is referred to as a limiting charge. The limiting charge is usually 15 percent (though sometimes less) above the Medicare-approved amount. The limiting charge applies only to specific services and doesn't apply to durable medical equipment and many other supplies. You may have to pay the full cost at the time the service is rendered. Medicare will then send you payment for its share of the cost when the claim is processed. Assignment is required to be accepted for prescriptions that are covered under Part B and home dialysis supplies and equipment.

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