What is Medicare? - AskCarolB

Original Medicare

This coverage includes:

Part A premium: Usually $0 cost / month

Standard Part B premium: $170.10* / month

YOU CAN ADD:

Part B (Medical Insurance)

Helps cover:

Services from doctors and other health care providers
An annual wellness visit
Many preventive services, like flu shots
Clinical laboratory services, like blood and urine tests
X-rays, MRIs, CT scans, EKGs, and other diagnostic tests
Some health programs, like smoking cessation and obesity
Physical, occupational and speech-language therapy
Diabetes screenings, education and certain supplies
Mental health care
Durable medical equipment for use at home, like wheelchairs, walkers, hospital beds, and other equip
Ambulatory surgery centers, ambulance and emergency room services

YOU CAN ALSO ADD:

Original Medicare is a federal health insurance program for eligible U.S. citizens and legal residents. It is funded in part by the FICA taxes you pay while working. It is individual health insurance that generally has a cost for each service. Here are the general rules for how it works: In most cases you can go to any doctor, health care provider, hospital, or facility that is enrolled in Medicare and accepting new Medicare patients. With a few exceptions, most prescriptions aren’t covered in Original Medicare. You can add drug coverage by joining a Medicare Drug Plan (Part D). In Original Medicare you don’t need to choose a primary care doctor or get a referral to see a specialist.

You generally pay a set amount for your health care (deductible) before Medicare pays its share. Then, Medicare pays its share, and you pay your share (coinsurance / copayment) for covered services and supplies. There’s no yearly limit for what you pay out-of-pocket. Part B has a premium and if your income is over a certain threshold, you may have to pay an additional amount called an IRMAA. You generally don’t need to file Medicare claims. The law requires providers and suppliers to file your claims for the covered services and supplies you get. Providers include doctors, hospitals, skilled nursing facilities, and home health agencies.

THINGS TO KNOW:

Original Medicare

Part A and Part B only covers about 80% of the cost for most medical bills. There is also a deductible for each Part.
There is no yearly limit on your out-of-pocket costs. That’s where Medigap comes in to bridge that gap.
If you don’t sign up for Part B when you’re first eligible, you may pay a late enrollment fee, unless you qualify for a Special Enrollment Period.
Medicare Part A: Your out-of-pocket costs include the Part A benefit-period deductible and coinsurance for the services you receive.
Medicare Part B Your out-of-pocket costs include the Part B calendar-year deductible, coinsurance for the services you receive any charges that exceed the Medicare-approved amount.

Medicare Supplement (Medigap or Med Supp)

You can buy a Medicare Supplement Insurance (Medigap) policy to help pay your Original Medicare out-of-pocket costs.
If you want this type of coverage and don’t buy a Medigap policy when you’re first eligible, you may go through underwriting.

Prescription Drug Plan (PDP)

If you want drug coverage, you can add a separate Drug plan (Part D).
If you don’t join a Drug plan (either through a stand-alone Drug Plan or through MedicareAdvantage) when you first get Medicare, you may pay a penalty for a long as you have Medicare drug coverage.

* Rate for 2022. Most people pay the Standard B premium amount. If your modified AGI (Adjusted Gross Income) as reported on your IRS tax return from 2 years ago is above a certain amount, we will need to send you the chart outlining the extra charge added to your premium called IRMAA.

Original Medicare

Part A (Hospital Insurance)

Medicare Supplment Plan (Medigap)

Part B (Medical Insurance)

Part D (Prescription Drug Plan - PDP)

Original Medicare

Medicare Supplement (Medigap or Med Supp)

Prescription Drug Plan (PDP)

source: Mediacare.gov

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