Medicare is the federal health insurance program for people 65 and over; for disabled individuals who receive SSDI through Social Security; and those with Lou Gehrig’s (ALS) or End Stage Renal Disease (ESRD). Your (red, white and blue) Medicare card has your unique identification number and the effective dates of Part A, Part B, or both.
Parts A and B are called Original Medicare. Original Medicare is also referred to as Traditional Medicare.
Part A covers 1) inpatient hospitalization; 2) treatment in a skilled nursing facility; 3) home health care; and 4) hospice.
Part B covers outpatient medical services such as 1) physician visits;2) laboratory and diagnostic tests; 3) ambulance; 4) urgent care and emergency room treatment. Part B also covers drugs administered in your doctor’s office or a medical facility.
Can I use my Medicare I.D. card to get medical care?
You can see any doctor, or go to any facility, which accepts Medicare anywhere in the country.
Original Medicare is inexpensive. Right?
It depends on how much you use it and what services you use it for.**
Part A is premium free if you’ve worked for ten years in the United States and paid into Social Security. However, if you’re admitted into the hospital as an inpatient, Medicare will bill you $1,675 per benefit period. A benefit period lasts 60 days. This is your Part A deductible.
The monthly premium for Part B is $185.00. Medicare pays 80% of outpatient services. You pay 20%. For usual and customary physician visits, your share of the cost is reasonable. For more intensive outpatient services, such as MRIs, CT Scans, ambulance costs and emergency room visits, 20% represents a significant amount of money
Part A and Part B do not pay for medications. You will need to enroll in a separate prescription plan (Medicare Part D).
What are the alternatives?
One alternative to Original Medicare is to enroll in a Medicare Advantage plan (Medicare Part C). These plans are offered by private insurance companies. They provide all the benefits of Medicare Parts A and B and include extra benefits, such as routine dental, vision and hearing. Many Medicare Advantage plans include prescriptions.
An important feature of Medicare Advantage is provider networks. Networks limit your choice of providers. Some plans require referrals to see specialists. If you travel outside your plan’s service area, your plan may only cover urgent and emergency care. Even with these limitations, the cost savings associated with Medicare Advantage plans may make them an attractive option. For more information on Medicare Advantage plans, go to ‘Medicare’ on the Services tab.
A second choice to offset costs is to enroll in a Medicare Supplement plan. As the name implies, these plans ‘supplement’ the costs of Medicare Parts A and B. For more information, please see my blog on Medicare Supplement Insurance.
*This site is not affiliated with or endorsed by any government agency.
**For a complete list of Original Medicare costs, go to www.medicare.gov. Call 725-227-6795, email ken@deserthealthandlife.com or fill out a contact form on this website with any questions. I am a licensed insurance broker.
