Medicare Part A & Part B
Although Medicare enters
into annual contracts with insurance companies and managed care plans to provide coverage through different types of health
plans, the original Medicare plan is available to everyone. Original Medicare is also sometimes called Medicare fee-for-service
(do not confuse with private fee-for-service) or traditional Medicare. You can go to any doctor or hospital that accepts Medicare.
Original Medicare coordinates with most group retirement plans, Medicaid, Medicare savings programs, and Medicare Supplements
(Medigap) insurance. CMS publishes a handbook, called Medicare and You,
which describes Medicare coverages and health plan options. The handbook is mailed to every Medicare beneficiary each year. Services Not Covered by Medicare Benefits - Long-term care services (generally
not covered)
- Custodial care, such as help walking, getting
in and out of bed, dressing, bathing, toileting, shopping, eating, and taking medicine (these are commonly referred to as
activities of daily living)
- More than
100 days of skilled nursing facility care during a benefit period following a hospital stay (the Medicare Part A benefit period
begins the first day you receive a Medicare-covered service and ends when you have been out of the hospital or a skilled nursing
facility for 60 consecutive days)
- Homemaker
services
- Private-duty nursing care
- Most dental care and dentures
- Health care received while traveling outside the United States,
except under limited circumstances
- Cosmetic surgery
and routine foot care
- Routine eye care, eyeglasses
(except after cataract surgery), and hearing aids.
What
You Will Have to Pay with Medicare Both Medicare Part A and Part B have costs that you must pay. These
include monthly premiums, deductibles, copayments, and coinsurance. You also pay the full cost of services not covered by
Medicare. Premiums are amounts
you pay regularly to keep your coverage. Most people do not have to pay a Part A premium, but everyone must pay the Part B
premium. The premium amounts may change each year in January. A deductible
is the amount you must pay for covered medical expenses before Medicare begins to pay. A copayment is a fixed charge for a medical service. Coinsurance is the percentage of the cost of a covered service that you pay after
Medicare pays its portion of the cost. Health care providers who accept "assignment" agree to limit their fee
to the Medicare-approved amount for a service or supply, although you must pay any deductibles, coinsurance, or copayments
due. Providers who do not accept assignment may charge as much as 15 percent above the Medicare-approved amount when
treating Medicare patients. You must pay the excess amount. The amount you owe is shown on the Medicare Summary
Notice that you receive from Medicare. If you were charged more than the 15 percent and paid it, your provider must refund
the excess charges to you within 30 days. If you believe a provider has overcharged you, question the bill before you pay
it and contact the Medicare carrier that processed your claim. |