When you first sign up for Medicare, and during certain times of the year, you can choose how you get your Medicare coverage.
Original Medicare
• Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
• You can join a separate Medicare drug plan to get Medicare drug coverage (Part D).
• You can use any doctor or hospital that takes Medicare, anywhere in the U.S.
• To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also shop for and buy supplemental coverage.
In general, Part A covers:
● Inpatient care in a hospital
● Skilled nursing facility care
● Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care)
● Hospice care
● Home health care
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.
Preventive 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 healthcare provider who accepts assignments.
Part B covers things like
● Clinical research
● Ambulance services
● Durable medical equipment (DME)
● Mental health
● Inpatient
● Outpatient
● Partial hospitalization
● Limited outpatient prescription drugs
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Medicare coverage is based on 3 main factors
● Federal and state laws.
● National coverage decisions made by Medicare about whether something is covered.
● Local coverage decisions made by companies in each state that process claims for Medicare.
Medicare Advantage (also known as Part C)
• Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.
• In most cases, you can only use doctors who are in the plan’s network.
• In many cases, you may need to get approval from your plan before it covers certain drugs or services.
• Plans may have lower out-of-pocket costs than Original Medicare.
• Plans may offer some extra benefits that Original Medicare doesn’t cover—like vision, hearing, and dental services.
Original Medicare vs. Medicare Advantage
Medicare Advantage: In many cases, you can only use doctors and other providers who are in the plan’s network and service area (for non-emergency care). Some plans offer non-emergency coverage out of network, but typically at a higher cost. You may need to get a referral to see a specialist.
Original Medicare: You can go to any doctor or hospital that takes Medicare, anywhere in the U.S. In most cases, you don’t need a referral to see a specialist.
Get started with Medicare It’s important for you to:
● Understand your Medicare coverage options.
● Find out how and when you can sign up.
● Mark your calendar with these important dates!
Open enrollment Medicare 2023 is here! This may be the only chance you have each year to change your coverage.
Know what are the best options to cover everything you need, Medicare drugs plan, and special cases. Contact us now and get a free quote!
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(626) 912-1988
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EPIA inc. is a private Insurance Agency with no ties with legal entities. The information contained in this article is based on information provided by the Medicare Official Website.