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What Does Original Medicare Cover?

Original Medicare is a health insurance program paid for by the federal government. It consists of Medicare Part A and Medicare Part B.

You’re eligible for Medicare benefits if you are:

65 or older

Younger than 65 with disabilities

Experiencing end-stage renal disease (kidney failure)


Medicare Part A

covers health care services, such as

Home health care (limited)

Hospice care

Inpatient hospital care

Lab tests

Surgery

While Medicare will cover your inpatient hospital stay, it doesn't cover long-term care or nursing home care.

For most people, Part A is free.

Medicare open enrollment takes place from Oct. 15 - Dec. 7. That's when all people eligible for Medicare can change their Medicare health plans and prescription drug coverage for the following year.

Medicare Part B

covers outpatient care and basic health services, including:

Ambulance services

Chemotherapy

Diabetes care and supplies

Doctors’ services

Durable medical equipment, such as wheelchairs, crutches and hospital beds

Immunizations, such as the flu and pneumococcal shot

Medically necessary diagnostic X-rays

Mental health care (outpatient)

Orthotics and prosthetics

Physical therapy

Preventive services, such as screenings, tests and well visits

Medicare Part B coverage costs for 2020:

  • Standard monthly premium is $144.60
  • Annual deductible for all Medicare Part B beneficiaries is $198

In most cases, you will pay 20% of the Medicare-approved amount for each item or service

Bridge the Gap With Medigap Plans

To help with costs not covered by Original Medicare, you can buy a Medicare supplement plan, also known as “Medigap.”

This private insurance helps cover:

With Medigap, you can choose any doctor or hospital that accepts Medicare without network restrictions.

The cost of Medigap policies varies. According to AARP, the nationwide average is $326 a month.

What’s the difference between Medicare Advantage and Medigap?

Medicare Advantage (Part C), offered by private insurers, takes the place of Parts A and B. Medicare Advantage adds additional benefits not covered by Medigap policies. So you will get all the benefits offered by Original Medicare plus services such as:

Dentist Care (coverage varies by plans)

Eye Exams

Gym Benefits

Hearing Aids

In-home Monitoring

Over-the-counter Drug Benefits

Transportation to Medical Appointments

Medicare Advantage (Part C Plans)

Comes In Several Forms:

Health Maintenance Organization (HMO) Plans

Preferred Provider Organization (PPO) Plans

Private Fee-for-Service (PFFS) Plans

Special Needs Plans (SNPs)

Medicare Advantage plans can range from $0 to several hundred dollars a month.

What About Prescription Drug Plans?

To get prescription drug coverage, you’d need to buy a Medicare Part D plan. Plans vary based on the list of prescription drugs they cover. They also divide the medication into different pricing and tiers. Our “guides” can assist you in learning more about prescription drug coverage and any other Medigap and Medicare Advantage questions you have. We look forward to helping you! Call us at 1-888-414-4547.

Medicare Plans

What it Covers?

Part A
Inpatient hospital care, skilled nursing, hospice, lab tests, surgery, limited home health care
Part B
Outpatient care, doctor appointments, screenings, chemotherapy, diabetic care, durable medical equipment, immunizations and preventive care
Medigap
Helps pay for costs not covered by Parts A and B, including co-payments and deductibles
Medicare Advantage (Part C)
Private insurance plans. Replaces Parts A and B and covers extras, such as dental, optical plans and hearing aids.
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