2631 Bulverde Rd Ste 102B, Bulverde, TX 78163

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River Oak Insurance

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Medicare

Medicare Basics

  

What is Medicare? 

Medicare is a federal health insurance program that pays most of the health cost for people who are 65 or older or are under 65 with certain disabilities. 


When are you eligible for Medicare?

  • 65 Years Old 
  • U.S. Citizen and resident (at least 5 consecutive years)
  • Special Situation (i.e. ESRD or ALS)

The Parts of Medicare: 


Part A: Hospital coverage

· In-patient hospital care

· Skilled nursing facilities care after a hospital stay 

· Home health care 

· Hospital care

· All but the first 3 pints of blood each calendar year


Part B: Medical coverage

· Medical expenses

· Home health care

· Clinical laboratory services

· Out-patient hospital services

· Durable medical equipment and supplies

· Preventative health services like exams, health screenings, and shots


Part D: Prescription drug plan

· Pays for generic and brand name prescription drugs

· Obtained from having a stand-alone prescription drug plan or by buying a Medicare Advantage plan

 

Part C: Medicare Advantage Plan

· Combines both Part A and B

· Most plans cover prescription drugs


Medicare Supplements: AKA Medigap policies, designed to fill in the gaps of Original Medicare. 

The gaps are:

· Part A Deductible 

· Part B Deductible 

· Part B Co-insurance 

· Part B Excess Charges 

· Foreign Travel Emergency 

 

What Medicare Does Not Cover:

Medicare doesn’t cover everything and there are important coverages you may qualify for to reduce your risk and out of pocket expenses:

· Custodial Care = nursing home, assisted living, home care, adult day care

· Hospital Indemnity = hospital copays on Medicare Advantage plan

· Cancer, Heart Attack, Stroke = out of pocket exposure with Medicare Advantage

· Dental/Vision = covered by select Medicare Advantage plans

· Final Expense = life insurance for burial expense 


Key Terms on What You Pay:

Premium: The amount you pay to keep your Medicare coverage. Everyone must pay a Part B premium. The amount may change every year in January. 

Deductible: the amount you pay for medical expenses before Medicare begins to pay. 

Copayment: The set dollar amount you usually have to pay to get a covered health service. 

Coinsurance: the percentage of the cost of a service that you pay after Medicare pays its portion of the cost. 


What is an Assignment?

On all Medicare-covered expenses, a doctor or other health care provider may agree to accept Medicare “assignment”. This means the patient will not be required to pay any of the expenses in excess of Medicare’s “approved” charge. The patient pays only 20% of the “approved” charge not paid by Medicare. Physicians who do not accept assignment of a Medicare claim are limited as to the amount they can charge for the covered services. In 2006, the most a physician can charge for services covered by Medicare is 115% of the fee schedule amount for non-participating physicians. 


For further information on Medicare, visit www.cms.gov 

Referenced from TDI website 

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Medicare

Medicare Supplments

Medicare Advantage Plans

Medicare Advantage Plans

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Prescription Drug Plans

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Medicare FAQ

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