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 $1,632 per benefit period. A benefit period lasts 60 days. This is your Part A deductible. There may be other inpatient hospital charges as well.
The monthly premium for Part B is $174.70. Medicare pays 80% of outpatient services. You pay the remainder (20%). Let’s say your primary doctor’s fee is $200.00. Your share is $40.00. This is a reasonable cost. However, if you get an MRI or CT scan; if you’re transported by ambulance; if you go to the emergency room, 20% can be significant. You will also pay $240.00 for Part B’s annual deductible.
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 at a lower cost and include extra benefits, such as routine dental, vision and hearing, which are not covered by Medicare. Many Medicare Advantage plans also include prescriptions.
An important feature of Medicare Advantage is provider networks. Networks limit your choice of providers. For example, you may want to see a doctor or go to a facility not contracted with a particular plan. Some plans require referrals to see specialists. Some may only cover urgent and emergency care outside of the plan’s service area. Even with these limitations, the cost savings associated with Medicare Advantage plans may still make them an attractive option. For more information on Medicare Advantage plans, go to ‘Medicare’ on the Services tab.
A second alternative 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 [email protected] or fill out a contact form on this website with any questions. I am a licensed insurance broker.
