Medicare Coverage: What You Need to Know
Medicare is a federally funded healthcare program that helps seniors and individuals with disabilities pay for their medical expenses. Expert in Medicare, Lindsay Malzone, can explain the difference between the most common Medicare plans.
Medicare Part A covers hospitalization, skilled nursing facility care, hospice services, home health care services (limited to 100 visits per calendar year), and some preventative screenings. Medicare Part B covers outpatient surgery, lab tests and other diagnostic tests not covered by Part A. It also covers certain preventive care measures like flu shots or mammograms as well as the costs of physical therapy treatments outside of hospitals. Medicare does not cover prescription drugs but it does offer help with paying for them through its “Part D” plan.
Also, Medicare insurance does not cover all of the costs for medical care. It only pays a percentage, or “prospective payment”, based on what it considers to be reasonable and customary charges in your area.
When you enroll with Medicare, there are three different plans that you can choose from: Part A alone (Hospital Insurance), Part B alone (Medical Insurance) or both Parts A &B together. In most cases, individuals who qualify should just sign up for both parts because they will receive better coverage by doing so but this is something that each individual has to decide for themselves when signing up. The first premium notice sent after enrollment asks whether the enrollee would like to pay monthly premiums through payroll deductions or cost-of-living adjustments if eligible.
The monthly premium for Medicare Part A and B is usually deducted from your Social Security Retirement benefits. This means that it’s important to make sure you’re getting credit for all of the earnings on which you might be eligible, including years when income was low or non-existent because social security retirement benefits are based only on what an individual earned during a certain period called “creditable coverage.”