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What Is Medicare?

What is Medicare?

Medicare is a health insurance program for people age 65 or older and people under age 65 with certain disabilities.

This section is meant to give you a brief overview of the various parts of Medicare.  For complete details please refer to the CMS Publication, Medicare and You

Learn more about the Medicare enrollment periods - including initial, general, and annual enrollment.

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Medicare Part A

Hospital Services

This portion of Medicare is what you have been paying your Medicare taxes on over the years and is provided premium free, as long as you worked 40 quarters.

There are deductibles and coinsurance with Part A coverage.

Part A provides coverage for:

  • Inpatient hospital stays
  • Stays at a skilled nursing facility (i.e., where medically necessary skilled nursing and rehabilitation care are provided).
  • Home health care
  • Psychiatric inpatient care
  • Hospice care
  • Blood (after the first 3 units) 

 


 

Medicare Part B

Out Patient Services

This portion of Medicare has a monthly premium that will be taken from your Social Security check or, you will be billed quarterly if not collecting Social Security. The current monthly premium is $134.00 and may be higher depending on your income.

The 2017 Part B calendar year deductible is $183.00 and 20% coinsurance.

Part B provides coverage for:

  • Ambulance Services
  • Ambulatory Surgical Centers
  • Blood (the first 3 units of blood are not covered unless you have the blood donated by you or someone else)
  • Chiropractic Services (limited)
  • Clinical Laboratory Services
  • Diabetes Supplies (note: insulin and certain medical supplies used to inject insulin, such as syringes, and some oral diabetic drugs may be covered by Medicare Prescription Drug coverage, Part D)
  • Doctor Services
  • Durable Medical Equipment (like walkers)
  • Emergency Department Services
  • Foot Exams and Treatment (if you have diabetes-related nerve damage and/or meet certain conditions)
  • Hearing and Balance Exams (if your doctor orders these tests to see if you need medical treatment. Hearing aids and exams for fitting hearing aids are not covered)
  • Home Health Services (covers only medically necessary services; you pay nothing)
  • Kidney Dialysis Services and Supplies
  • Mental Health Care (you pay 20% of the medicare-approved amount for a visit to a doctor or other health care provider to diagnose your condition; you pay 45% for treatment of your condition
  • Non-doctor Services (such as physician assistants, nurse practitioners, social workers, physical therapists, and psychologists)
  • Outpatient Medical and Surgical Services and Supplies
  • Physical Therapy (there may be limits on these services and exceptions)
  • Prescription Drugs (limited number of drugs such as injections you get in a doctor's office, certain oral cancer drugs, drugs used with some types of durable medical equipment, such as a nebulizer or external infusion pump)
  • Prosthetic/Orthotic Items
  • Urgently-Needed Care

 


 

Medicare Part C

Medicare Advantage Plans

Part C, commonly referred to as Medicare Advantage (MA) plans, is an alternative to Parts A and B. A Medicare Advantage plan is offered by private insurance companies who are approved by Medicare. These health plans may be HMOs, PPOs, or private fee for service (PFFSs) plans. MA plans may have a premium in addition to your Part B premium.

Depending on the MA plan selected there may be deductibles, copays and coinsurance.

Medicare Part C coverage or a Medicare Advantage plan includes:

  • Your Medicare Part A (Hospital Services) and Part B (Out Patient Services) coverage
  • These plans may provide other services such as prescription drug, dental, vision, hearing and wellness coverage.

For more details see Medicare Advantage.

 


 

Medicare Part D

Prescription Drug Plans

Part D, provides prescription drug coverage for Medicare participants. These plans are provided by private companies approved by Medicare. The premium for Part D coverage varies by the plan selected.

There are 2 ways to get Part D coverage:

  • Standalone if you only have Medicare Part A and Part B coverage.
  • Included in your Medicare Advantage plan.

This is a general outline of how the Part D prescription drug plan works for 2017. Each plan may operate a bit differently so it is important to fully understand which plan will work best for you.

  • Annual Plan Deductible - $0 to $400
  • Initial Coverage Period – you have copays or 25% coinsurance
  • Coverage Gap (Donut Hole) – Begins at $3701 (you pay 40% of brand and 51% of generic drug costs)
  • Catastrophic Coverage – over $7425, you pay the greater of 5% of drug price or a small copay.

Before deciding on a standalone drug card you should carefully review your drugs on www.Medicare.gov to determine which card will work best for you. This is a service we provide to our clients.


This section is meant to give you a brief overview of the various parts of Medicare.  For complete details please refer to the CMS Publication, Medicare and You

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