Medicare Basics

medicare basics

Start with Medicare Basics

Know how Medicare works, then choose what works for you

Original Medicare is provided by the federal government. It offers coverage for:

🏥Hospital stays and inpatient care. This is called Part A.

👨‍⚕️Doctor Visits. This is called Part B- you pay a monthly premium for it.

Original Medicare does NOT include prescription drug coverage

💊Prescription drug coverage: This is called Part D and is not included with Original Medicare. You are not required to enroll in a Part D when you first become eligible for Medicare. If you enroll in a Part D plan in the future, then you will pay a penalty equal to about 1% of the average monthly premiu, for each month you delayed enrollment. This must be paid monthly as long as you are enrolled in Part D.

Depending on your needs, you may want to add more coverage to Original Medicare

Option 1: Enroll in a Medicare Advantage plan

⚕️Also called part C

They combine Part A and Part B. most Medicare Advantage plan also include Part D, so your hospital, medical, and prescription drug insurance is all in one plan

🔍Extras

Some plans may include extra benefits not includeed with Original Medicare. For example: Dental, vision, and hearing coverages.

Option 2: Add one or both of these to Original Medicare

☂️ Medicare Supplement

Helps pay for some of the costs not covered by Original Medicare.

💊Medicare Part D Plan

Helps pay for prescription drugs and helps you avoid that 1% penalty

Original Medicare Cost Share Information

Since Original Medicare does not cover 100% of the cost of the covered services, it is pivotal to either enroll in a Medicare Advantage Plan or a Medicare Supplement plan to get full coverage. Note that some services are not covered under Original Medicare, for example: Dental, vision, and wellness are not covered.

Original Medicare

Monthly Plan Premium

Medicare part A & B premium if not otherwise paid for under Medicaid or by another thrid party.

Medicare Deductible

In 2022, the Part B deductible is $233

Maximum Out-of-Pocket Responsibility (does not include prescription drugs)

There is no limit to how much you will pay for covered services

Original Medicare

Inpatient Hospital Coverage

In 2022 the amounts for each benefit period are: $1556 deductible for days 1 through 60. $389 copay per day for days 61 through 90. $778 copay eadh day for days 91 to 150 (lifetime reserve days). Covers 90 days for an inpatient hospital stay.

Doctor Visits

20% of the cost per visit

Preventive Care

$0 copay

Emergency Care

20% of the cost. If you are admitted to the hospital within 3 days, you do not have to pay your share of the cost for certain services. If you are treated in a hospital emergency room and then admittedd as a hospital inpatient during the same visit, you do not need to pay cost sharing on the hospital bill for the ER. But you are responsible for cost sharing on the physician services during both the ER adn the inpatient stay.

Urgently Needed Services

20% of the cost per visit

Original Medicare

Diagnostic Tests, Lab and Radiology Services and X-rays

20% of the cost of all radiology. $0 copay for lab services.

Heaering Services

20% of the cost

Dental Services

Limited dental services. 20% of the cost

Vision Care

20% of the cost of exams to diagnose and treat diseases of teh eye.

Mental Health Care

20% of the cost for outpatient therapy

Skilled Nursing Facility

Check the Medicare Guide

Rehabilitation Services

20% of the cost for Occupational therapy and physical therapy

Ambulance

20% of the cost

Routine Transportation

Not covered

Fooot Care (Posiatry Services)

20% of the cost

Welllness Program

Not covered

Medicare Part B Drugs

20% of the cost

Outapatient Surgery

20% of the cost
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