Healthcare in America is not simple. While Medicare delivers services to many people, we believe many recipients may not fully appreciate the scope of Medicare services, how services are covered under Parts A through D, etc. Here’s a brief summary:
WHAT IS MEDICARE?
- Medicare is a federal health insurance program administered by the Centers for Medicare & Medicaid Services.
- Medicare covers:
- Most people age 65 or older.
- Younger individuals who are receiving Social Security Disability benefits
for a period of 24 months or longer. - People of all ages with End-Stage Renal Disease (permanent kidney failure
requiring dialysis or a kidney transplant).
MEDICARE BASICS
- Medicare is health insurance for people age 65 and over and disabled individuals.
- Medicare Part A covers the hospital insurance program, including hospital expenses skilled nursing facilities, home healthcare and hospice care.
- Medicare Part B is the supplemental medical insurance program, covering physicians’ services and miscellaneous ancillary healthcare expenses.
- Medicare Part C, also known as Medicare Advantage Plans, is a replacement
of the original Medicare coverage by a private insurance company. - Medicare Part D provides medication coverage.
MEDICARE PART A
Medical Benefits and Services Covered Under Medicare Part A:
- Hospital Benefits
- Skilled Nursing Facility Benefits
- Home Health Services Benefits
- Hospice Benefits
- Care in Psychiatric Hospitals
- Blood Deductibles
MEDICARE PART B
Medical Benefits and Services Covered Under Medicare Part B:
- Physician services and supplies as part of such services
- Physical therapy, speech pathology, OCC therapy
- Surgical dressings, splints, casts, medical supplies
- Necessary ambulance services
- Rental of durable medical equipment used in the home
- Preventive Services
- Bone mass measurements for certain people at high risk
- Colorectal cancer screening tests for persons age 50 and over
- Diabetes self management services: monitors, test strips, training
- Glaucoma screening for “high risk” patients
- Mammogram screening for women age 40 and over at certified facility
MEDICARE PARTS A AND B
Medical Benefits and Services Not Covered Under Part A or B:
- Most prescription drugs and medicines taken at home
- Services performed by a relative or household member
- Services outside the U.S. except for qualified Canadian and Mexican facilities
- Routine physical exams, eye exams, glasses, hearing aids, and dental care
- Routine foot care and orthopedic shoes, except for diabetics
- Most chiropractic services
- Custodial care
- Cosmetic surgery (except after an accident)
- Most immunizations
- Private nurses
MEDICARE PART C
Medical Benefits and Services Covered Under Medicare Part C:
- Preferred Provider Organization Plans (PPO)
- Health Maintenance Organization Plans (HMO)
- Private Fee For Service Plans (PFFS)
- Medical Savings Account Plans (MSA)
- Special Needs Plans (SNP)
MEDICARE PART D
Part D Prescription Drug Coverage:
- Medicare prescription drug coverage is available to Medicare beneficiaries
- The Medicare Beneficiary may choose to elect and enroll for Part D benefits upon
eligibility - Private companies provide prescription drug coverage. Beneficiaries choose the drug
plan they wish to enroll in, and most pay a monthly premium - Formulary
- Prescription Drug coverage
- Exclusions
