Medicare

Deductible

The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.

Premium

The periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage.

Benefit period

The way that Original Medicare measures your use of hospital and skilled nursing facility (SNF) services. A benefit period begins the day you're admitted as an inpatient in a hospital or SNF. The benefit period ends when you haven't gotten any inpatient hospital care (or skilled care in a SNF) for 60 days in a row. If you go into a hospital or a SNF after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There's no limit to the number of benefit periods

What is the difference between original Medicare and Medicare Advantage?

advantage is a plan offered by a private company that contracts with Medicare. Medicare Advantage Plans provide all of your Part A and Part B benefits and often prescription drugs original medicare is only parts A and B

What does part A cover?

- Inpatient care in a hospital • - Inpatient care in a skilled nursing facility (not custodial or long-term care) - Hospice care - Home health care - Inpatient care in a religious nonmedical health care institution

Medically necessary

Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.

What is a Formulary?

A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list

Medicare Advantage

Medicare Advantage is an "all in one" alternative to Original Medicare. These "bundled" plans include Part A, Part B, and usually Part D Plans may have lower out-of-pocket costs than Original Medicare In most cases, you'll need to use doctors who are in the plan's network. Most plans offer extra benefits that Original Medicare doesn't cover— like vision, hearing, dental, and more

What does Part B cover?

Medicare Part B (Medical Insurance) helps cover medically necessary doctors' services, outpatient care, home health services, durable medical equipment, mental health services, and other medical services. Part B also covers many preventive services

What does a supplement (Medigap) plan cover and why people get them?

Medicare Supplement Insurance policies, sold by private companies, can help pay some of the remaining health care costs for covered services and supplies, like copayments, coinsurance, and deductibles. Medicare Supplement Insurance policies are also called Medigap policies.

Original Medicare cost

- You generally pay a set amount for your health care (deductible) before Medicare pays its share. Once Medicare pays its share, you pay a coinsurance or copayment for covered services and supplies. There's no yearly limit for what you pay out-of-pocket. - You usually pay a monthly premium for Part B.

Copayment

An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor's visit, hospital outpatient visit, or prescription drug. A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor's visit or prescription drug

Coinsurance

An amount you may be required to pay as your share of the cost for services after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).

What does taking assignment mean?

Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services If your doctor, provider, or supplier accepts assignment: - Your out-of-pocket costs may be less. - They agree to charge you only the Medicare deductible and coinsurance amount and usually wait for Medicare to pay its share before asking you to pay your share. - They have to submit your claim

People who get medicare part A and B automatically

If you're already getting benefits from Social Security or the Railroad Retirement Board (RRB) If you're under 65 and have a disability If you have ALS

Who hast o sign up for Part A and/or B

If you're close to 65, but not getting Social Security or Railroad Retirement Board (RRB) benefits If you have End-Stage Renal Disease (ESRD) If you live in Puerto Rico you have to buy part B

Lifetime reserve days

In Original Medicare, these are additional days that Medicare will pay for when you're in a hospital for more than 90 days. You have a total of 60 reserve days that can be used during your lifetime. For each lifetime reserve day, Medicare pays all covered costs except for a daily coinsurance.

Medicare-approved amount

In Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you're responsible for the difference.

Medicare parts A and B do NOT cover

Most dental care Eye exams related to prescribing glasses. Dentures. Cosmetic surgery Massage therapy. Routine physical exams. Acupuncture. Hearing aids and exams for fitting them Long-term care Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care)

Do you have to pay a premium for Medicare A if you have paid into the system during your working years?

No

Custodial care

Non-skilled personal care, like help with activities of daily living like bathing, dressing, eating, getting in or out of a bed or chair, moving around, and using the bathroom. It may also include the kind of health-related care that most people do themselves, like using eye drops. In most cases, Medicare doesn't pay for custodial care

What are the different parts of Medicare?

Part A (Hospital Insurance) Part B (Medical Insurance) Part D (Prescription drug coverage)

Original Medicare

Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). If you want drug coverage, you can join a separate Part D plan. To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also shop for and buy supplemental coverage Can use any doctor or hospital that takes Medicare, anywhere in the U.S.

Durable Medical Equiptment

PART B Medicare covers items like oxygen and oxygen equipment, wheelchairs, walkers, and hospital beds ordered by a doctor or other health care provider enrolled in Medicare for use in the home. Some items must be rented. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

What are Medicare Advantage Plans and what they have to cover?

PART C A type of Medicare health plan offered by a private company that contracts with Medicare. Medicare Advantage Plans provide all of your Part A and Part B benefits. Medicare Advantage Plans include: - Health Maintenance Organizations - Preferred Provider Organizations - Private Fee-for-Service Plans - Special Needs Plans - PACE Medicare Medical Savings Account Plans If you're enrolled in a Medicare Advantage Plan: Most Medicare services are covered through the plan Medicare services aren't paid for by Original Medicare Most Medicare Advantage Plans offer prescription drug coverage.

What are PACE programs?

Programs of All-inclusive Care for the Elderly (PACE) organizations are special types of Medicare health plans. PACE plans can be offered by public or private companies and provide Part D and other benefits in addition to Part A and Part B benefits

Do you have to be a citizen to get Medicare?

Yes

Is there a premium for Medicare B?

Yes, $135.50 in 2019

What does Part D do?

covers prescription drugs