MedicareWire has been answering questions about Medicare benefits and coverage for its visitors since January 2012. Since then we’ve seen just about every conceivable question there is about the federal health insurance program. Here are the top 100+ questions we’ve answered.
What is the difference between Original Medicare and Medicare Advantage plans?
Medicare Advantage (also known as “Medicare Part C”) offers additional insurance coverage in place of Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage.. Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). are provided by private insurers on a yearly contract; providing benefits that can change annually. For most healthy seniors, Medicare alone takes care of about 80% of all health care needs. For a modest monthly premium, a Medicare Advantage insurance plan may take care of the rest, but usually, have deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share. and co-pays that also may change by plan year.
The benefit of Medicare Advantage is that it combines Original Medicare coverage for hospital stays, doctor visits, outpatient careOutpatient Care is medical care that does not require an overnight stay at the hospital. Medicare Part B provides coverage for Outpatient Care., and preventive medicine into a single program that’s easy to manage. In other words, it makes your health care benefits easy. Plus, many Medicare Advantage policies provide extra benefits, including vision, hearing, and prescription drug coverage.
What is a Medicare Supplement Plan?
Medicare Supplement policies (also known as “Medigap” policies) help pay some of the health care costs that your Original Medicare Plan does not cover. If you have Original Medicare and add a Medicare Supplement policy, both will pay their share of all covered health care costs. Medicare Supplement policies provide lifetime guarantees that other plans may not.
Medicare Supplement plansMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. are standardized and do not change from year to year. Benefits, co-pays, and deductibles are constant and vary only by plan type. Medicare Supplements can only be canceled, or changed, by the policy owner, not the insurance company.
Every type of Medicare Supplement policy — identified as plans A through N — must adhere to federal and state laws. This makes the buying process easier for the consumer. The benefits of each plan type are identical regardless of the carrier providing the insurance. Some insurers add additional benefits like gym memberships, consumer discount cards, 24/7 nurse hotlines, and 6 to 12-month rate guarantees at no additional cost for the policy owner. However, plan premiumsA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. are not standardized and may vary between companies based on several factors.
What’s the Difference Between Medicare Advantage and a Medicare Supplement?
A Medicare Supplement plan is an insurance policy designed to pay for specific health care expenses that are not covered by Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. or Part B. Each of the ten plans (A through N) has different combinations of benefits and deductibles. Although Medicare Supplement plans always have more benefits than Medicare Part A and Part B, they do not offer prescription drug coverage. For prescription drug coverage, you must add a Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... plan.
Medicare Advantage policies are health plans offered by private insurance companies. They provide the standard hospitalization and medical coverage of Medicare Part A and Part B plus additional coverage so the member has limited out of pocket expenses. In most cases, a Medicare Advantage plan may include additional benefits that are not part of original Medicare such as prescription drug coverage.
What is the “Welcome to Medicare” physical exam?
Medicare covers a one-time preventive physical exam within the first 12 months that you have Part B. The examination includes an in-depth review of your health, education, and counseling about the preventive services you need (like certain screenings and shots), and referrals for other care. You also get a chance to speak with your doctor about how to stay healthy.
What types of services does Medicare cover?
Medicare Part A helps cover your inpatient careInpatient care refers to care provided in a hospital or other inpatient facility. Inpatients are admitted and stay at least one night depending on their condition. in hospitals, critical access hospitals, and skilled nursing facilities. Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. helps cover your doctors’ services, outpatient hospital care, and some other medical services that Part A does not cover, such as some of the services of physical and occupational therapists, and some home health careHealth care services and supplies a doctor decides you may receive in your home under a plan of care established by your doctor. Medicare only covers home health care on a limited basis as ordered....
How do I submit a Medicare claim?
If you are in the Original Medicare Plan, Medicare providers that are enrolled in the Medicare program are required to file Medicare claims for the services and supplies you receive. You will not be required to file any Medicare claims.
Why are preventive health care services important?
Preventive services are designed to identify health problems early when treatment works best. Plus, diagnosing symptoms early can keep you from getting certain diseases or illnesses. To help keep you healthy, Medicare pays for many preventive services. Talk with your health care providerA person or organization that’s licensed to give health care. Doctors, nurses, and hospitals are examples of health care providers. to find out what tests you need and how often you need them to stay in good health.
Medicare vs. Medicaid, what’s the difference?
MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. and Medicare may sound similar, but they are two very different programs. Medicaid is a state governed program for seniors with low income and Medicare is a federal governed program for all seniors. You apply for Medicaid at your state’s Medicaid agency. You apply for Medicare at your local Social Security office.
Should I sign up for Medicare Part A and B if I am still working?
Even if you keep working after you turn 65, you should sign up for Medicare Part A. If you have health coverage through your employer or union, Part A may still help pay some of the costs not covered by your group health planA group health plan is a health plan offered by an employer or employee organization that provides health coverage to employees, their families, and retirees.. You may be able to wait to sign up for Medicare Part B if you or your spouse are working and have group health coverage through you or your spouse’s employer or union.
If you are age 65 or older and working for a small company with fewer than 20 employees, you should talk to your employee health benefits administrator before making any decision not to take Medicare Part B. If your employer has less than 20 employees, Medicare is the primary payer and your group health insurance would be the secondary payer.
Can I delay Medicare Part B enrollment without a penalty?
Yes. In certain cases, you can delay your Medicare Part B enrollment without having to pay higher premiums. If you didn’t take Medicare Part B when you were first eligible because you or your spouse were working and had group health plan coverage through your or your spouse’s employer or union, you can sign up for Medicare Part B during a Special Enrollment PeriodSpecial Enrollment Periods (SEPs) allow beneficiaries to change their Medicare Advantage and Part D plans due to a special circumstance. Common reasons for a SEP include moving, losing employer coverage, and Medicaid eligibility, to name....
Who qualifies for Medicare-covered home health care?
If you have Medicare, home health care services are covered if you meet all the following conditions:
- Your doctor must decide that you need medical care at home, and make a plan for your care at home.
- You must need intermittent skilled nursing care, physical therapy, speech-language therapy, or a continuing need for occupational therapy.
- The home health agency caring for you must be approved by the Medicare program.
- You must be homeboundHomebound refers to a person who is unable to leave their home due to a medical condition. Homebound individuals can still leave home for brief periods for non-medical reasons such as graduation, family reunions, funerals, and..., or normally unable to leave home without help. To be homebound means that leaving home takes considerable and taxing effort. You can be homebound and still leave home for medical treatment or short, infrequent absences for non-medical reasons, such as trips to a barber or church. A need for adult day care doesn’t keep you from getting home health care.
How do I get a replacement Medicare card?
If your Medicare card is lost, stolen, or damaged, you can ask for a new one via the Social Security Administration website. Your red, white and blue card will be mailed within 30 days to the address SSA has on file for you. If you need proof that you have Medicare sooner than 30 days, you also can request a letter that you will receive in about 10 days. If you need proof immediately for your doctor or for a prescription, visit your nearest Social Security office.
Does Medicare cover eye care and eyeglasses?
Generally, Medicare doesn’t cover eyeglasses or contact lenses. However, following cataract surgery with an intraocular lens, Medicare helps pay for cataract glasses, contact lenses, or intraocular lenses provided by an ophthalmologist. Services provided by an optometrist may be covered if the optometrist is licensed to provide this service in your state.
Will Medicare pay for my nursing home stays?
Under certain limited conditions, Medicare will pay some nursing home costs for Medicare beneficiaries who require skilled nursing or rehabilitation services. To be covered, you must receive the services from a Medicare-certified skilled nursing home after a qualifying hospital stay. A qualifying hospital stay is the amount of time spent in a hospital just prior to entering a nursing home. This is at least three days. To learn more about Medicare payment for skilled nursing home costs, contact your State Health Insurance Assistance Program (SHIP) in your State.
Why does Social Security charge me for Medicare Part B when I have a Medicare Advantage plan?
Medicare Advantage plans provide care under contract to Medicare. You must continue to pay the monthly Medicare Part B premiumThe Medicare Part B premium is the monthly charge paid by beneficiaries for their outpatient medical care, services, and supplies. A beneficiary's premium may be uplifted by an IRMAA surcharge if their income is above... when you join a Medicare Advantage plan. You may also have to pay an additional monthly premium to the plan. For the plan premium, the plan may provide benefits like coordination of care or reduce out-of-pocket expenses. If you join a Medicare Advantage plan, you are still in the Medicare program and are still entitled to get all your regular Medicare-covered services and have Medicare rights and protections.
Does Medicare cover visits to a chiropractor?
Manual manipulation for subluxation of the spine is the only chiropractic service that is covered by Medicare. A chiropractor is defined in the Social Security Act as a physician for only one service, manual manipulation or treatment of subluxation of the spine. You don’t need an X-ray to prove you have a subluxation of the spine.
Some Medicare Advantage plans may provide chiropractic coverage benefits. You should check with your Medicare Advantage plan directly to see what chiropractic services are covered.
Are my spouse and children covered by Medicare?
Medicare is not offered as a family or dependent benefit. This means all people who have Medicare, must qualify on an individual basis. For example, a person under age 65 does not automatically receive Medicare because their spouse is 65 or older and enrolled in the Medicare program. In addition, when a parent qualifies for Medicare, this does not entitle their dependent children to Medicare coverage.
What supplies does Medicare cover for diabetics?
Medicare covers some diabetes supplies, including blood glucose test strips, blood glucose monitors, lancet devices and lancets, and glucose control solutions for checking the accuracy of test strips and monitors. There may be limits on how much or how often you get these supplies.
Am I covered by Medicare when I travel outside of the United States?
The Original Medicare Plan generally doesn’t cover health care while you are traveling outside the United States, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. In some rare cases, Medicare can pay for inpatient hospital services that you get in Canada or Mexico.
Does Medicare Part B cover medical supplies and equipment?
Medicare Part B helps pay for durable medical equipmentDurable medical equipment (DME) is equipment that is designed to last and can be used repeatedly. It is suitable for home use and includes wheelchairs, oxygen equipment, and hospital beds. such as oxygen equipment, wheelchairs, walkers, and other medically necessaryServices or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice. equipment that your doctor prescribes to use in your home. Other items covered by Medicare include:
- arm, leg, back and neck braces,
- medical supplies such as ostomy bags, surgical dressings, splints, and casts,
- breast prostheses following a mastectomy, and
- one pair of eyeglasses with an intraocular lens after cataract surgery.
Medicare pays for different kinds of durable medical equipment in different ways. Some equipment must be rented; other equipment must be purchased.
Do I have to pay for Medicare Part A?
You will not have to pay for Medicare Part A if you worked and paid Medicare taxes for at least 10 years. If you did not pay Medicare taxes while you worked and you are age 65 or older, you may be able to buy Part A.
What are Health Savings Accounts (HSAs)?
A Health Savings Account (HSA) is tax-free savings that you can deposit money into for current and future qualified medical expenses for you and your family. This includes most medical care, including dental and vision care, long-term carea variety of services that help people with their medical and non-medical needs over a period of time. Long-term care can be provided at home, in the community, or in various types of facilities, including... expenses, and insurance. The program is voluntary. There is an annual maximum amount of money you can deposit into your HSA that’s determined by the Internal Revenue Service (IRS).
Does Medicare cover ambulance services?
Medicare pays for limited ambulance services. If you go to a hospital or skilled nursing facility (SNF), ambulances are covered for medically-necessary services if transportation in any other vehicle could endanger your health.
Am I required to join a Medicare drug plan?
Joining a Medicare drug plan is your choice. However, to have Medicare help pay for your drugs, you must join a plan that provides Medicare prescription drug coverage. You can choose and join a plan that meets your needs. If you don’t use a lot of prescription drugs now, you should still consider joining. For most people, joining when you are first eligible for Medicare means you won’t have to pay a penalty if you choose to join later. Your premium will be higher if you wait to join because of the penalty.
Is mental health care covered by Original Medicare?
Medicare Part A covers inpatient mental health care, including room, meals, nursing, and other related services and supplies. Medicare Part B covers mental health services generally given outside a hospital, including visits with a doctor, clinical psychologist, clinical social worker, and lab tests.