Learn about Medicare and what it covers Part 1

These are the top 10 Medicare questions we hear from people around the country.

I will  try to answer them for you today.

• First, we’ll define what Medicare is and who is eligible for it.

 • Next, we’ll talk about Medicare coverage options and costs.

• Then, we’ll touch on how to choose coverage and explain the different enrollment periods.

• Last, we’ll talk about how you may be able to save money and where you can find more information. When we’re done, if you have more questions, we’ll try to answer those, too.  You can easily get in touch with me and you can also comment under this video and I will answer each and every question under this video.

This presentation is divided in a few parts. So please make sure to watch all videos in order – for a better understanding  of Medicare program.

Let’s get started.

There are some common misperceptions about Medicare, so let’s go over a few basic facts about what Medicare is and what it’s not.

Medicare is health insurance for older and disabled Americans. It’s funded in part by federal payroll taxes paid by employees and employers. You may see the deduction on your paystub labeled “FICA.” Medicare is not a family health plan. Each person must meet Medicare eligibility requirements as an individual, and each person is covered as an individual. For example, one spouse may turn 65 and enroll in Medicare while the other spouse is not yet eligible. Finally, Medicare is different from Social Security. It’s also different from Medicaid – which is health insurance for people with limited income and resources. And, while your tax dollars help pay for Medicare, you will still have some costs. Medicare is not free. We’ll talk more about costs in just a bit.

So we said that Medicare is individual insurance. But who can get it?

As you might guess, there are eligibility requirements for Medicare. First, Medicare is for U.S. citizens and for legal residents living in the U.S. for at least the previous 5 years. You must be age 65, or have a qualifying disability and have received disability benefits for 24 months. People with end-stage renal disease or ALS may be eligible sooner. Each individual enrolled in Medicare gets a card with a unique number on it. Numbers are randomly generated and assigned. You can see here what a Medicare card looks like. Up to this year [2018], Medicare used Social Security numbers on cards. Medicare is mailing replacement cards with new numbers on them to all current beneficiaries. If you have a card with your Social Security number on it, you can use that card until your new one arrives. The switch to random numbers is to help protect your personal identity

Let’s move on to what Medicare covers. You may have heard about the different parts of Medicare: A, B, C and D. We’ll explain each part, and we’ll also talk about Medicare supplement insurance, or Medigap.

First up is Original Medicare, which is the core coverage provided by the federal government. It has two parts:

 •Part A is hospital insurance.

•Part B is medical insurance.

Let’s look at each of these, starting with Part A.

Part A, hospital insurance, covers services provided during an inpatient hospital stay. Most covered services are listed here. This includes your room, your meals, and nursing and other services. One important thing you may notice missing from the list is doctor services. That’s because doctor services are covered by Part B, even when you’re in the hospital. Another thing to point out is that if you want a TV or phone in your room, you may have to pay for it. Part A doesn’t cover these items. It also doesn’t cover custodial care, which is care that helps with daily life activities like eating and bathing.

Here are some additional important facts about Part A

. Part A has a premium but few people pay it. Remember the FICA payroll tax?

 If you paid that for 10 or more years, you get Part A premium free.

You can’t be denied Part A coverage, regardless of your health or financial status.

And you’re covered at any hospital in the country that accepts Medicare.

Finally, you need to know a few terms to understand Part A benefits.

• Part A coverage and costs are based on benefit periods. A benefit period begins the day you are admitted to the hospital and ends after you’ve been out for 60 days in a row.

 • Observation status is another important term. Part A covers hospital stays when you are admitted as an inpatient by doctor’s orders, not if you're there for observation, even if you stay overnight.

Part B would pay some of these costs.

• Lifetime reserve days are extra covered hospital days you can draw on if you are in the hospital longer than 90 days, the maximum length of stay covered in a benefit period. You get 60 lifetime reserve days. Each can be used only once, but they can be applied to different benefit periods. We’ll come back to these terms in a bit when we talk about costs.

Now let’s look at Part B, medical insurance.

The main covered services are listed here, including doctor visits, the tests or exams your doctor might order and other outpatient services. Also, as we just discussed, Part B covers doctor services when you’re in the hospital as well.

 There are a couple of things to point out here.

• First, the Annual Wellness Visit is an opportunity to meet with your doctor to discuss your health status and goals – things that a regular visit may not provide time for. It’s covered 100%, with no copay, as long as it sticks to its purpose. If the discussion veers into current health problems, like a cough, for example, then there may be a cost. It’s good to know this ahead of time to prevent any surprises.

• The second thing to point out is about medical equipment (also called durable medical equipment, or DME). To be covered, the equipment needs to be medically necessary and prescribed by a doctor. It also needs to come from a supplier approved by Medicare. So, in most cases, you can’t just buy a walker somewhere and have Medicare pay for it. Talk to your doctor first.

Here are some additional important facts about Part B.

Part B has a monthly premium. If you’re receiving Social Security or Railroad Retirement Board benefits, the amount will be deducted from your check each month. Again, we’ll talk more about costs in a just a minute. Just as with Part A, you can’t be denied Part B coverage, regardless of your health or financial status. And you may see any provider in the country that accepts Medicare. Finally Part B charges a premium penalty for late enrollment, unless you qualify for a Special Enrollment Period. We’ll cover enrollment later in the presentation but some people, including those who work past age 65, may delay Part B enrollment without penalty. Please watch  and read Part 2 to find out what is not covered by Medicare. Again, if you haven’t subscribed yet, please subscribe to our channel for new videos and information that will help you manage your finances, learn about health insurance benefits including Medicare, learn how to effectively save money, find deals, bargains and so much more!