Medicare coverageHow to choose the right Medicare coverage for you
If you’re 65 or older, you may be eligible for Medicare. Medicare is a federal health insurance program. Some people younger than 65 may be eligible because of a disability or end-stage renal disease (ESRD). ESRD is permanent kidney failure. People with ESRD may need dialysis or a kidney transplant.
The four parts of Medicare and what they cover
Medicare Part A, or hospital insurance, helps cover inpatient hospital care, inpatient skilled nursing facility care, hospice care and some home healthcare. It doesn't cover long-term care or custodial care, which is help with daily activities such as bathing, dressing, and using the bathroom.
Medicare Part B, or medical insurance, helps cover medically necessary doctors' services, outpatient care, home health services, durable medical equipment (DME), and many preventive services. Here are some examples of what Part B does and doesn't help cover:
- Part B covers hearing and balance exams if your healthcare provider orders them to see if you need a medical treatment.
- Part B may help cover physical, occupational, and speech therapy when your doctor or other healthcare provider certifies you need it. There may be a limit on the amount Medicare will pay for these services in a single year. There may also be certain exceptions to these limits.
- Part B also covers chiropractic services, specifically adjustment of the spine if medically necessary to correct a subluxation. Subluxation is when one or more of the bones of your spinal column are out of alignment. The service must be provided by a chiropractor or other qualified provider. Medicare doesn't cover massage therapy or acupuncture.
- Part B covers DME, such as patient lifts, if your doctor prescribes one for use at home. Part B also covers the cost of buying or renting other DME, including canes, crutches, wheelchairs, walkers, oxygen equipment, hospital beds and blood sugar monitors.
Some people choose Medicare Part C. These are Medicare Advantage plans offered by private companies like Humana. The plans enter into contracts with Medicare to provide an enrollees' Part A and Part B benefits.
Medicare Part D adds prescription drug coverage to Original Medicare. It also adds coverage to some Medicare plans offered by private companies, including Medicare Advantage plans. Each plan has its own list of covered drugs, called a formulary, or drug list.
The plan can make changes to this list during the year within Medicare guidelines. You might be surprised to learn that while Medicare doesn't cover Viagra, some Medicare Part D plans may cover Cialis, another drug for erectile dysfunction.
Don’t be afraid to ask questions
Of course, Medicare doesn't cover everything, and even when it does cover a test, item or service, you usually have to pay a deductible, coinsurance or copayment. Talk to your doctor about why he or she is recommending certain services or tests to help better estimate your costs.
The amount you have to pay out-of-pocket depends on several factors. Do you have Medicare Supplement insurance, also known as Medigap insurance, to pay for things Part A and Part B don't? Will your healthcare providers or equipment suppliers accept Medicare assignment, which means they agree (or are required by law) to accept the Medicare-approved amount as full payments for covered services?
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