Medicare 101: Making Your Health Care Coverage Options Easy To Understand
Simple questions like "What is Medicare?" or "What are my health care options?" are oftentimes followed by complex answers. Medicare beneficiaries, their loved ones and caregivers may be left even more confused and even doubtful about their health care coverage.
That's why Touchstone Health created this "Medicare 101" series in everyday language. We will dive into world of Medicare, breaking down benefits into easy to understand information.
This four part series will explain:
- Original Medicare
- Medicare Parts A and B
- Medicare Parts C and D
- Your Medicare Coverage Options?
Part I: WHAT IS ORIGINAL MEDICARE?
In this first installment of Touchstone Health's "Medicare 101", we are going to explore the ins and outs of Original Medicare.
So What is Original Medicare?
Medicare is a fee-for-service health insurance plan provided by the government. Fee-for-service means you have to pay a set amount for each type of service you get before Medicare pays its share.
Original Medicare is composed of Parts A and B, providing coverage hospital and medical insurance coverage directly. Part A is hospital insurance, which helps cover inpatient care in hospitals, skilled nursing facilities, hospices and home health care. Part B is medical insurance, which helps cover doctors" services, hospital outpatient care and home health care. Part B also helps cover some preventive services to help maintain your health.
Who Can Get Original Medicare?
To be eligible for Medicare, you must be 65 or older, under 65 with certain disabilities, or have End-Stage Renal Disease (ESRD) -- permanent kidney failure requiring dialysis or a kidney transplant). You may be automatically enrolled in Part A and Part B under certain circumstances.
If you are turning 65 within the next 3 months, or have turned 65 within the past 3 months, now is the time to select a plan if you haven't already done so. Waiting too long could leave you without medical coverage and cost you more in the long run.
Call Social Security at 1-800-772-1213 for more information about your Medicare eligibility, and to sign up for Part A and/or Part B.
What Do You Pay with Original Medicare?
You usually have to pay a deductible (a set amount for your health care) before Medicare pays its share. Then, Medicare pays its share, and you pay your share (coinsurance/copayment) for covered services and supplies. There is no yearly limit for what you pay out-of-pocket.
You may be eligible for premium-free Part A coverage. However, you usually pay a monthly premium for Part B.
Can You Go to Any Doctor or Hospital?
You can go to doctor, supplier, hospital or facility that is enrolled in Medicare and is accepting new Medicare patients.
Are Prescription Drugs Covered?
Most prescription drugs are not covered under Original Medicare. You need to sign up for a Part D Medicare Prescription Drug Plan if you want comprehensive prescription drug coverage.
Do You Need to Choose a Primary Care Doctor?
No.
Do You Have to Get a Referral to See a Specialist?
No, but the specialist needs to accept Medicare.
How Do You File Claims?
You usually don't need to file Medicare claims. The law requires providers (like doctors, hospitals, skilled nursing facilities, and home health agencies) and suppliers to file your claims for the covered services and supplies you get.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
We hope this gives you a greater understanding of Original Medicare. Next up, we will explain Medicare Part A and Part B in more detail in the next edition of Touchstone Health's "Medicare 101".
That's why Touchstone Health created this "Medicare 101" series in everyday language. We will dive into world of Medicare, breaking down benefits into easy to understand information.
This four part series will explain:
- Original Medicare
- Medicare Parts A and B
- Medicare Parts C and D
- Your Medicare Coverage Options?
Part I: WHAT IS ORIGINAL MEDICARE?
In this first installment of Touchstone Health's "Medicare 101", we are going to explore the ins and outs of Original Medicare.
So What is Original Medicare?
Medicare is a fee-for-service health insurance plan provided by the government. Fee-for-service means you have to pay a set amount for each type of service you get before Medicare pays its share.
Original Medicare is composed of Parts A and B, providing coverage hospital and medical insurance coverage directly. Part A is hospital insurance, which helps cover inpatient care in hospitals, skilled nursing facilities, hospices and home health care. Part B is medical insurance, which helps cover doctors" services, hospital outpatient care and home health care. Part B also helps cover some preventive services to help maintain your health.
Who Can Get Original Medicare?
To be eligible for Medicare, you must be 65 or older, under 65 with certain disabilities, or have End-Stage Renal Disease (ESRD) -- permanent kidney failure requiring dialysis or a kidney transplant). You may be automatically enrolled in Part A and Part B under certain circumstances.
If you are turning 65 within the next 3 months, or have turned 65 within the past 3 months, now is the time to select a plan if you haven't already done so. Waiting too long could leave you without medical coverage and cost you more in the long run.
Call Social Security at 1-800-772-1213 for more information about your Medicare eligibility, and to sign up for Part A and/or Part B.
What Do You Pay with Original Medicare?
You usually have to pay a deductible (a set amount for your health care) before Medicare pays its share. Then, Medicare pays its share, and you pay your share (coinsurance/copayment) for covered services and supplies. There is no yearly limit for what you pay out-of-pocket.
You may be eligible for premium-free Part A coverage. However, you usually pay a monthly premium for Part B.
Can You Go to Any Doctor or Hospital?
You can go to doctor, supplier, hospital or facility that is enrolled in Medicare and is accepting new Medicare patients.
Are Prescription Drugs Covered?
Most prescription drugs are not covered under Original Medicare. You need to sign up for a Part D Medicare Prescription Drug Plan if you want comprehensive prescription drug coverage.
Do You Need to Choose a Primary Care Doctor?
No.
Do You Have to Get a Referral to See a Specialist?
No, but the specialist needs to accept Medicare.
How Do You File Claims?
You usually don't need to file Medicare claims. The law requires providers (like doctors, hospitals, skilled nursing facilities, and home health agencies) and suppliers to file your claims for the covered services and supplies you get.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
We hope this gives you a greater understanding of Original Medicare. Next up, we will explain Medicare Part A and Part B in more detail in the next edition of Touchstone Health's "Medicare 101".