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Medicare

Get to Know Medicare

Who can get Medicare?

U.S. citizens and legal residents
Legal residents must live in the U.S. for at least 5 years in a row, including the 5 years just before applying for Medicare.

You must also meet one of the following requirements:

  • Age 65 or older.
  • Younger than 65 with a qualifying disability.
  • Any age with a diagnosis of End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).

Medicare Coverage

Medicare has different parts that help cover specific services:

Medicare Part A (Hospital Insurance) - Part A helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits. Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working.

Medicare Part B (Medical Insurance) - Part B helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. Most people pay a monthly premium for Part B.

Medicare Part D (Prescription Drug Coverage) - Medicare prescription drug coverage is available to everyone with Medicare. To get Medicare prescription drug coverage, people must join a plan approved by Medicare that offers Medicare drug coverage. Most people pay a monthly premium for Part D.

What’s not covered by Part A and Part B?

Medicare doesn't cover everything. Some of the items and services Medicare doesn't cover include:

  • Long-term care (also called custodial care)                                                 
  • Most dental care
  • Eye exams related to prescribing glasses
  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and exams to fit them
  • Routine foot care

Medicare Advantage (Part C)

Another way to get your Medicare benefits:

  • An alternative to Original Medicare.
  • Plan members are still in the Medicare program.
  • Benefits are administered by the plan.
  • Plans offered by private insurance companies.

All Medicare Advantage plans cover:

  • All the benefits of Part A (except hospice care, which is still covered by Part A).
  • All the benefits of Part B.

Most Medicare Advantage plans cover:

  • Prescription drugs (Part D).
  • Preferred Provider Organization plans (PPO).

Medicare Advantage plans may offer additional benefits, such as:

  • Dental exams, cleanings and X-rays.
  • Eye exams, eyeglasses and corrective lenses.
  • Hearing tests and hearing aids.
  • Wellness programs and fitness memberships.

Medicare Advantage plans have an annual out-of-pocket maximum to help protect against high costs.

There are different types of Medicare Advantage (Part C) Plans:

Coordinated care plans:

  • Health Maintenance Organization plans (HMO)
  • Preferred Provider Organization plans (PPO)
  • Point of Service plans (POS)
  • Special Needs Plans (SNP)

Other plan types:

  • Private Fee-For-Service plans (PFFS)
  • Medical Savings Account plans (MSA)

Medicare Advantage (Part C) Fast facts:

  • Must be enrolled in both Medicare Part A and Part B and live in plan service area.
  • Can’t be denied coverage based on current financial or health status, including pre-existing conditions.
  • May be required to use provider and pharmacy networks.
  • Coverage and costs vary by plan and may change each year.
  • Annual limit on out-of-pocket costs for covered services.
  • May charge a monthly plan premium.
  • Must continue to pay Part B premium to Medicare.

Medicare Supplement Insurance (Medigap)

Medigap is Medicare Supplement Insurance that helps fill "gaps" in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:

  • Copayments
  • Coinsurance
  • Deductibles

Some Medigap policies also cover services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, here's what happens:

  • Medicare will pay its share of the Medicare-approved amount for covered health care costs.
  • Then, your Medigap policy pays its share.

Medigap policies generally don't cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

There are two ways to get prescription drug coverage:

  • Medicare Prescription Drug Plan (Part D) . These plans (sometimes called "PDPs") add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
  • Medicare Advantage Plan (Part C) like an HMO or PPO) or other Medicare health plan  that offers Medicare prescription drug coverage. You get all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MAPDs.” You must have Part A and Part B to join a Medicare Advantage Plan.

Medicare Costs

To review Medicare Part A, Part B, Part C and Part D costs at a glance, visit Medicare.gov.

                 

               

           

Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.

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