The original Medicare Plan (Part A) provides hospital insurance to people 65 or over and those who meet special criteria and runs on a fee-for-service basis. Doctors are also limited as to what they can charge you for their services. As long as you or your spouse paid your Medicare taxes while you were working, you normally will not have to pay a monthly premium for Part A coverage. You also have the option of adding Part B and Part D, and will be enrolled in Part A automatically once you turn 65 unless you opt for Medicare Advantage.
Even if you did not pay Medicare taxes before retirement, you can still buy Part A if you are over 65 years old and meet US citizenship and residency requirements, or if you are under 65, disabled, and lost your premium-free Part A coverage because you went back to work. More often than not, if you opt to buy original Medicare Plan coverage, you are required to buy Part B as well as pay both services’ premiums. If you have limited income, your state may provide financial assistance for your Part A and B coverage.
Medicare hospital insurance includes a variety of medically-necessary services, like hospital stays (a minimum of 3 days), so long as you do not need long term or custodial care. Part A consists of semi-private rooms, hospital services and supplies, the doctor, emergency room services, and drugs that you are prescribed for your treatment. Hospital services like anesthesia, chemotherapy, and inpatient dialysis are covered by Part A as long as they are deemed medically necessary. Personal care items and private rooms are not covered by Medicare Part A.
Blood is another service that the original Medicare program covers. As long as the hospital receives blood from a blood bank without any charge, you do not need to worry about payment. However, if the hospital needs to purchase blood for you, you must repay the hospital for the blood or you or someone else can done blood. This service includes blood transfusions as well as other blood work you are given in a hospital.
Hospice, skilled nursing facility, and home health services are also covered by Part A. If you have a terminal illness, and your doctor has confirmed that you have 6 months or less to live, your hospice care (including pain relief, grief counseling, and other service) will be covered by Medicare. In order to receive skilled nursing facility care, a doctor must declare that you are in need of daily skilled care like physical therapy. Home health services are also covered, provided they are ordered by a doctor and are also supplied by a Medicare certified home health agency: you must be determined home-bound in order to receive these services, and the home health services are again limited to medically necessary care.
Traditional Medicare provides you with a semi-private room and meals in hospitals, hospitals, and nursing facilities. These services do not include private nursing or private rooms, and unless deemed medically necessary, also do not cover long term or custodial care. Televisions and telephones are also not covered if they incur an additional charge.
Part B of Medicare provides qualifying US citizens with outpatient medical insurance, which covers doctors’ services, preventative services, and other forms of outpatient care. You can enroll in Part B medical insurance three months before and four months after your 65th birthday. There is also a special enrollment period for those who are covered by a group health plan offered by a union or employer.
If you are already receiving benefits from Social Security or the Railroad Retirement Board, you will automatically enroll in Part B the month you turn 65: if your birthday is on the first of the month, you will enroll in Part B on the first day of the previous month. If you are disabled and under the age of 65, you automatically get Part B once you receive Social Security disability benefits. Most people must pay a monthly premium depending on their income to ensure Part B coverage. The premium is usually deducted from your monthly Social Security payments depending on income.
You can chose to opt out of Part B by sending the Medicare Part B card back when you receive it in the mail: by keeping the card, you keep Part B and keep paying Part B premiums. If you chose not to enroll during your initial enrollment period, you have the opportunity to register in the general enrollment period that stretches from January 1 to May 1. For every 1 year period that you were qualified to enroll in but opted not to your Part B monthly premium will increase by 10 percent.
Medicare Part B provides patients with medically necessary outpatient health care. Part B fills in some of Part A’s gaps by providing coverage for doctors in an outpatient setting as well as for approved medical equipment and supplies when necessary. Physician services, nursing services, vaccinations, cardiovascular and diabetes screenings, lab services, and other preventative services can all be covered by Part B. Routine physical exams are not covered by Part B.Medicare Part B will not pay for cosmetic surgery, custodial care, prescription drugs, dental care, or vision care, as well as other services.
Medicare does not cover every health-related service or item. You will likely have to pay copayments and deductibles on services even if they are covered by Medicare. Most copayments will cost around 20 percent of the total cost of the service. If a service you need is not covered by Medicare, you must cover the costs yourself unless you have separate insurance.
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