What is Original Medicare?
Medicare was signed into law on July, 30th 1965 for people age 65 and older. Before Medicare came into affect, it was increasingly hard for older individuals to obtain health insurance. Medicare has improved the health & lifespan of seniors and was expanded to people with disabilities, ESRD and to work along side Medi
Medicare Part A
Medicare Part A
Medicare Part A often referred to as "Hospital Insurance" covers the following:
- Home Health Care: Physical Therapy, Occupational Therapy, Speech Language pathology, Part-Time or Intermittent Skilled Nursing Care, Part-time or intermittent home health aide services (personal hands-on care), Medical Social Services, Injectible osteoporosis drugs for women.
A doctor must certify that you need these services
- Inpatient Care In A Hospital:
What kind of hospital is this referring too?
Local hospital, acute care hospital, critical care access hospitals, inpatient rehab facilities, long term care hospitals, inpatient care during a qualifying clinical research study, and inpatient mental health care from a psychiatric hospital or psychiatric unit in the hospital.
What exactly does inpatient care in a hospital cover for me?
This covers semi-private hospital rooms, meals, general nursing, drugs that are apart of your hospital stay, hospital services and supplies. This does not cover a private room (unless medically necessary), private nurse, television, telephone calls, or personal items such as slippers, socks, razors, etc.
- Inpatient Care In A Skilled Nursing Facility (Not Custodial Or Long Term Care)
- Inpatient Care In A Religious Nonmedical Health Care Institution
- Hospice Care
Is Medicare Part A free?
Did you or your spouse pay Medicare taxes for 40 quarters of work which means 10 years? If so, yes , there will be no Medicare premium, however, you do have to pay co-payments, coinsurance or deductibles for your treatment.
Medicare Part B
Medicare Part B
Medicare Part B often referred to as "Medical Insurance" covers the following:
- Abdominal aortic aneurysm screening- Medicare will cover this for you one time if you're at risk and it must be referred by a doctor.
- Advance care planning
- Alcohol Misuse Screening & Counseling
- Ambulance Services
- Ambulatory surgical centers
- Behavioral health integration services
- Blood
- Bone mass measurement (bone density)
- Breast cancer screening (mammogram)
- Cardiac rehabilitation
- Cardiovascular disease (behavioral therapy)
- Cardiovascular disease screenings
- Cervical and vaginal cancer screenings
- Chemotherapy
- Chiropractic services (limited coverage)
- Chronic care management services
- Clinical research studies
- Colorectal cancer screenings
- Continuous Positive Airway Pressure (CPAP) therapy
- Defibrillator (implantable automatic)
- Depression screening
- Diabetes Screenings, Self Management Training, Diabetes equipment, supplies & therapeutic shoes.
- Doctor and other health care provider services
- Durable medical equipment (DME)
- EKG or ECG (electrocardiogram) screening
- Emergency department services
- Eyeglasses (after cataract surgery)
- Federally Qualified Health Center (FQHC) services
- Flu shots
- Foot exams and treatment
- Glaucoma tests
- Hearing and balance exams
- Hepatitis B shots
- Hepatitis B Virus (HBV) infection screening
- Hepatitis C screening test
- HIV (Human Immunodeficiency Virus) screening
- Home health services
- Kidney dialysis services and supplies
- Kidney disease education services
- Laboratory services
- Lung cancer screening
- Medical nutrition therapy services
- Mental health care (outpatient)
- Obesity screening and counseling
- Occupational therapy
- Opioid use disorder treatment services
- Outpatient hospital services
- Outpatient medical and surgical services and supplies
- Physical therapy
- Pneumococcal shots
- Prescription drugs (limited)
- Prostate cancer screenings
- Prosthetic/orthotic items
- Pulmonary rehabilitation
- Rural Health Clinic (RHC) services
- Second surgical opinions
- Sexually transmitted infection (STI) screening and counseling
- Shots (or vaccines)
- Smoking and tobacco-use cessation (counseling to prevent tobacco use & tobacco-caused disease)
- Speech-language pathology services
- Surgical dressing services
- Telehealth
- Tests (other than lab tests)
- Transitional care management services
- Transplants and immune suppressive drugs
- Travel (health care needed when traveling outside the U.S.)
- Urgently needed care
- “Welcome to Medicare” preventive visit
- Yearly “Wellness” visit
Is Medicare Part B Free?
Medicare monthly premiums are based on your modified adjusted gross income (MAGI). If you're single and your income was less than $87,000 or you're married filing jointly with an income of $174,000, you will pay the standard premium. Standard part B premiums are $144.60 a month for the year 2020. For high incomes, premiums rise to as high as $491.60 a month. If the Part B annual deductible applies to you. The Part B annual deductible is $198 for the year. You must pay all costs up to the Medicare Approved Amount until you meet the yearly Part B deductible. After your deductible is met, Medicare will begin to pay it's share. You typically pay 20% of the Medicare approved amount for service. There's NO yearly limit for what you pay out of pocket. Preventative services are usually free of charge. The services must be from a doctor or other qualified health care provider who accepts Medicare. However, for some preventive services, you may have to pay a deductible, coinsurance, or both. These costs may also apply if you get a preventive service in the same visit as a non-preventive service.
Frequently Asked Questions About Original Medicare
Can I go to any health care provider, Hospital or Specialist with Medicare?
Yes, as long as that provider accepts Medicare. That also means you can keep your primary physician and the specialist you've been seeing for years, as long as they accept Medicare. We can check for you if they accept Medicare or you can check at Medicare.gov
Are my Prescription Drugs covered?
No but there are exceptions like if medication is apart of your inpatient medical care. Otherwise, you will need a Medicare Prescription Drug Plan to add to your plan to have insurance for prescriptions. Please visit the PDP section of this website & contact us for more information. More information can also be found at Medicare.Gov
Am I covered by Medicare when I travel internationally?
Medicare does not cover medical treatment outside the USA and it's territories. However, there are special circumstances that will be covered.
- Medicare will pay for emergencies in Canada if you are traveling a direct route between Alaska and another state and the closest hospital is in Canada.
- Medicare will pay for medical care you receive on a cruise ship if the cruise ship is in USA territories.
- Medicare will cover emergency or non emergency services if the closest hospital is in a foreign country. For example: You live on the border of Texas & Mexico but the closest hospital is in Mexico.
it's important to note that Select Medigap polices provide coverage for traveling abroad. Some Medicare Advantage plans provide coverage for traveling abroad as well. Please contact us to find out more about Medigap plans or click here. You can also find more information about Medigap polices at Medicare.gov
I currently have Medicaid but have to sign up for Medicare, what do I do?
Please contact us.