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DIFFERENT MEDICARE OPTIONS

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Medicare Advantage

 

Also known as Medicare Part C, or Mas/MA-PDs

Medicare Advantage plans are medical insurance plans offered by private companies, approved by Medicare, that offer the same benefits as Original Medicare and may provide additional benefits like vision, dental coverage, hearing benefits, health and wellness programs (Silver Sneakers), and some prescription drug coverage. There are different types of Medicare Advantage plans to choose from. Medicare Advantage Plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-for-Service Plans (PFFS), Special Needs Plans (SNP).

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Original Medicare

 Original Medicare is provided the federal government and is made up of Parts A and B.

Part A is hospital insurance that covers: 

  • Inpatient hospital and rehabilitation facility care, including x-rays, surgeries and radiation treatment
  • Skilled nursing facility, hospice and home health care


Part B is medical insurance that covers:

  • Outpatient hospital and home health care
  • Ambulance, doctor and preventive services

You'll pay a monthly premium for Part B.  The premium is usually deducted from or taken out of your Social Security check. 

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Medicare Part A

 

Inpatient hospital care: This is care received after you are formally admitted into a hospital by a physician. You are covered for up to 90 days each benefit period in a general hospital, plus 60 lifetime reserve days. Medicare also covers up to 190 lifetime days in a Medicare-certified psychiatric hospital.

Skilled nursing facility (SNF) care: Medicare covers room, board, and a range of services provided in a SNF, including administration of medications, tube feedings, and wound care. You are covered for up to 100 days each benefit period if you qualify for coverage. To qualify, you must have spent at least three consecutive days as a hospital inpatient within 30 days of admission to the SNF, and need skilled nursing or therapy services.

Home health care: Medicare covers services in your home if you are homebound and need skilled care. You are covered for up to 100 days of daily care or an unlimited amount of intermittent care. To qualify for Part A coverage, you must have spent at least three consecutive days as a hospital inpatient within 14 days of receiving home health care. (Note: You can get home health care through Medicare Part B if you do not meet all the requirements for Part A coverage.)

Hospice care: This is care you may elect to receive if a providerdetermines you are terminally ill. You are covered for as long as your provider certifies you need care.

Keep in mind that Medicare does not usually pay the full cost of your care, and you will likely be responsible for some portion of the cost-sharing (deductibles, coinsurances, copayments) for Medicare-covered services.

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Medicare Part B

Medicare Part B provides outpatient/medical coverage. The list below provides a summary of Part B-covered services and coverage rules:

  • Provider services


  • Home health services


  • Ambulance services


  • Preventive services


  • Therapy services


  • Mental health services

 

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Medicare Part C (a.k.a. Medicare Advantage)

  • Covers all your Parts A and B benefits
  • May cover your prescription drugs, too
  • May also offer extra benefits, like vision or dental coverage or a fitness membership
  • May require you to see network doctors or specialists
  • Caps your out-of-pocket spending to protect your finances


You may pay a monthly premium for Part C.  You must keep paying your Part B premium, too.  

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Medicare Part D

Part D covers most outpatient prescription drugs (drugs you fill at a pharmacy). Check your plan’s formulary to find out whether it covers the drugs you need. Note: There are a few drugs that can be covered by either Part B or Part D depending on the circumstances.