Understanding Medicare

Medicare 101Mental Health Services
Understanding Medicare- 50% for most outpatient Mental Health Care
This document was created to empower people withOther Covered Services
a better understanding of the Medicare system.  A- Copayment or Coinsurance amounts
better understanding will help you make an informedOutpatient Hospital Services
decision, instead of being sold by a smooth talking- Coinsurance or copayment amount that varies by
salesman…..  Yes I am an insurance professional, butservice
I am a Christian first and abhor salesman that pushPart B Deductible
products.  I believe in educating consumers about all- The first $135 yearly for Part B covered services or
of their options.  Once properly informed they willitems
make the correct decision for themselves.Medicare Part C
Medicare is a GREAT health insurance program!! Another way to get your Medicare benefits. It
The problem is most people feel intimidated by it. combines Part A, Part B, and, sometimes, Part D
They are overwhelmed by the choices and get(prescription drug) coverage. Medicare Advantage
frustrated and ultimately turned off by the wholePlans are managed by private insurance companies
system.  That is unfortunate, but hopefully this articleapproved by Medicare. These plans must cover
will clear up some of these issues. medically-necessary services. However, plans can
Medicare is a health insurance program designed forcharge different copayments, coinsurance, or
seniors (people 65 & older) and people with certaindeductibles for these services.
disabilities.  It covers Hospitalization costs (MedicareMedicare Part D
Part A) and doctors or outpatient services (MedicareHelps cover prescription drugs. This coverage may
Part B).  It was signed into law in 1965 by Lyndon B.help lower your prescription drug costs and help
Johnson.  It has gone through many changes over theprotect against higher costs in the future.
years and now there is also Medicare Part C (alsoWhat is not covered by Medicare Part A or Part B
called Medicare Advantage) and Medicare Part DItems and services that Medicare doesn’t cover
(prescription Drug coverage).include, but aren’t limited to, the following:
Who is eligible for Medicare?- Acupuncture
- People age 65 & older- Chiropractic services
- People under age 65 with certain disabilities- Cosmetic surgery
- People of all ages with end-stage renal disease - Custodial care (like help with bathing or using the
 bathroom), except when you also get skilled nursing
How to start Medicarecare in a skilled nursing facility, at home, or in a
Medicare will start automatically for people turning 65. hospice 
Medicare will send out information to you a few- Deductibles, coinsurance, or copayments when you
months prior to your 65th birthday.  You will get aget certain health care services. People with limited
Medicare welcome package, which includes aincome and resources may get help paying these
Medicare & You book (filled with everything you couldcosts.
possibly want to know about Medicare), and your- Dental care and dentures (with only a few
Medicare ID card.  This will have your Medicare Claimexceptions) 
# as well as your Part A & Part B effective dates of- Eye care (routine exam), eye refractions (exam that
coverage.  The Part A & Part B effective dates ofmeasures your ability to see at specific distances), and
coverage should be the 1st day of your birthdaymost eyeglasses
month.  So if you were born on July 17th, your Part A- Foot care (routine), like cutting corns or calluses (with
& Part B effective dates of coverage would be July 1.few exceptions) 
How much does Medicare cost?- Hearing aids and exams for the purpose of fitting a
For most Americans Medicare Part A is free. hearing aid 
Medicare Part B costs for most people $96.40 /- Hearing tests that haven’t been ordered by your
month.  This is for people with individual income levelsdoctor 
up to $82,000 or jointly $164,000 a year.  The monthly- Most Laboratory tests for screening purposes
premium will be higher for people with higher income- Long-term care, for example, if you only need
levels.custodial care in a nursing home 
- Orthopedic shoes (with few exceptions) 
What does it cover?- Physical exams (routine or yearly). Medicare will
Medicare Part Acover a one-time physical exam within the first 6
Helps cover your inpatient care in hospitals. Part A alsomonths of enrolling in Part B (coinsurance and Part B
helps cover skilled nursing facility, hospice, and homedeductible applies)
health care if you meet certain conditions.- Prescription drugs. Most prescription drugs aren’t
Bloodcovered by Part A or Part B
- All costs for the first 3 pints of blood you get as an- Shots to prevent illness
inpatient, then Medicare approved amount for additional- Syringes or insulin, unless the insulin is used with an
pints of blood (unless you or someone else donate toinsulin pump, but it may be covered by Medicare
replace what’s used).prescription drug coverage (Part D) 
Home Health Care- Travel (Most health care while you’re traveling
- $0 for Home Health Care services.   20% of theoutside the United States)
Medicare approved amount for durable equipment.Medicare Coverage Options
Hospice CareMedicare Supplement Insurance
- Copayment of up to $5 per prescription forHealth insurance policies sold by private insurance
outpatient prescription drugs and 5% of the Medicarecompanies to fill "gaps" in Original Medicare Plan
approved amount for inpatient respite care (short termcoverage that assist in paying for some of the health
care given by another caregiver, so the usualcare costs that the Original Medicare Plan doesn’t
caregiver can rest).  You may have to pay room andcover, plus benefits not covered by Original Medicare,
board if you get hospice care in a facility other thanlike emergency health care outside the United States
short term general in-patient care or respite care.(subject to plan purchased).
Hospital StayYou pay a monthly premium to the private health
- $1,024 Deductible and no co-insurance for days 1-60insurance company that sells you the policy. Medicare
each benefit periodand the Medicare Supplement policy both pay their
- $256 per day for days 61-90 each benefit periodshares of covered health care costs.
- $512 per “lifetime reserve day” after day 90Medicare Advantage Plans
each benefit period (up to 60 days over your lifetime)Health plan options that are approved by Medicare but
Skilled Nursing Facility Stayrun by private companies. They are part of the
- $0 for the first 20 days each benefit periodMedicare Program, and sometimes called "Part C."
- $128 per day for days 21-100 each benefit periodWhen you join a Medicare Advantage Plan, you are
- All costs for each day after day 100 in the benefitstill in Medicare. Some of the plans require referrals to
periodsee specialists.
Medicare Part BIn many cases, the premium can be lower than they
Helps cover medically-necessary services likeare in the Original Medicare Plan or the Original
doctors’ services and outpatient care. Part B alsoMedicare Plan with a Medicare Supplement policy.
helps cover some preventive services to help maintainMedicare Health Plans charge different premiums and
your health and to keep certain illnesses from gettinghave different costs of services, so it is important to
worse.check with the plan before you join.
Clinical Laboratory ServicesThey generally offer extra benefits, and many include
- $0 for Medicare covered servicesprescription drug coverage.
Home Health CareIn many cases, your costs for prescription drug
- $0 for Home Health Care services.   20% of thecoverage can be lower than in the stand-alone
Medicare approved amount for durable equipment.Medicare Prescription Drug Plans.
Medical & other servicesSome of the plans coordinate your care, using
- 20% of the Medicare approved amount for mostnetworks and referrals, more than others. This can
doctor services, outpatient therapy, most preventivehelp manage your overall care and can also result in
services, and durable medical equipmentsavings to you.