Page 3 - Senior Times South Central Michigan - October 2016 - 23-10
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Senior Times - October 2016
Page 3
MEDICARE ALPHABET SOUP
Private-Fee-for-Service Plans, and
Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.
Medicare coverage is based on three main factors.
1. Federal and state laws.
2. National coverage decisions made
by Medicare about whether something
is covered.
3. Local coverage decisions made by
companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.
Talk to your doctor or other health care provider about why you need certain services or supplies, and ask if Medicare will cover them. If you need something that’s usually covered and your provider thinks that Medicare won’t cover it in your situation, you’ll have to read and sign a notice saying that you may have to pay for the item, service or supply.
You can visit the Medicare website directly to check to see if your item, service or supply is covered at www.medicare.gov/coverage/ your-medicare-coverage.html.
Not sure what kind of coverage you have? • Check your red, white, and blue
Medicare card.
• Check all other insurance cards that
you use. Call the phone number on the cards to get more information about the coverage.
• Check your Medicare health or drug plan enrollment.
• Call 1-800-MEDICARE (1-800-633- 4227). TTY users should call 1-877- 486-2048.
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessary to treat a disease
or condition.
There are two main ways to get your
Medicare coverage – Original Medicare
or a Medicare Advantage Plan (Part C). Before you make a decision, you can get local, personalized Medicare counseling from the State Health Insurance Assistance Program (SHIP). Most often your Area Agency on Aging, Commission on Aging, or Millage program will offer these services.
If you’re in a Medicare Advantage Plan
or other Medicare plan, you may have different rules, but your plan must give you at least the same coverage as Original Medicare. Some services may only be covered in certain settings or for patients with certain conditions.
Reach out to Medicare directly
for additional information at 1-800- MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Visit the website at medicare.gov
for information anytime day or night.
Part A (Hospital insurance):
In general, Part A covers:
• Hospital care
• Skilled nursing facility care
• Nursing home care (as long as custodial
care isn’t the only care you need)
• Hospice
• Home health services
Part B (Medical insurance)
Part B covers two types of services. Medically necessary services: Services
or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.
Part B covers things like:
• Clinical research
• Ambulance services
• Durable medical equipment (DME) • Mental health
- Inpatient
- Outpatient
- Partial hospitalization
• Getting a second opinion before surgery
• Limited outpatient prescription drugs
Medicare Part C (Medicare
Advantage Plans): A type of Medicare health plan offered by a private company
that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for- Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans.
If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.
Medicare Part D (prescription drug coverage): Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare
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