Untangling Medicare

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Whether you’re a senior, or helping out an elderly loved one, Medicare can be complicated. This article unpacks the intracicies of Medicare and sums them up into a few main points.

Medicare coverage comes in two types: Original Medicare or Medicare Advantage Plan. Both plans offer coverage based on three main factors:

-Federal and State laws

-National coverage decisions made by Medicare

-Local decisions made by individual companies

Original Medicare

Within Original Medicare, there are two types which include different services and monthly costs. When choosing a type of Original Medicare, the patient’s medical needs should match the services offered by the type.

Part A, or hospital insurance, ranges from $227 to $413 per month. However, a patient can qualify for premium-free Part A if he or she is over the age of 65 and already receives retirement benefits from Social Security or if the patient or the spouse had Medicare-covered government employment. If the patient is under the age of 65, the patient must have had Social Security or Railroad Retirement Board disability benefits for 24 months or have had End-Stage Renal Disease to qualify for premium-free Part A.

Services for Part A include

-Hospital care

-Skilled nursing facility care

-Nursing home care


-Home Health services

Those who choose to buy Part A may also have to buy Part B and pay monthly premiums for both.

Part B, or medical insurance, costs $134 per month. Receivers of Social Security benefits, Railroad Retirement Board, and Office of Personnel Management often pay less than this amount with the cost of Part B automatically deducted from their benefit payment. Late fees will ensue if the patient has not signed up for Part B as soon as he or she is eligible. Fees can reach up to an additional %10 per month. The patient’s annual income may also affect cost.

Part B covers two types of services:

-Medically necessary services that are needed to diagnose or treat illnesses

-Preventive services to prevent illnesses and detect it at an early stage

Medicare Advantage Plan

If the patient chooses the Medicare Advantage Plan, or Part C, the out-of-pocket costs depend on some different factors:

-Whether the plan charges a monthly premium

-Whether the plan pays any of your monthly Medicare Part B

-Whether the plan has a yearly deductible or any additional deductibles.

-How much you pay for each visit or service (copayment or coinsurance). For example, the plan may charge a copayment, like $10 or $20 every time you see a doctor. These amounts can be different than those under Original Medicare.

-The type of health care services you need and how often you get them.

-Whether you go to a doctor or supplier who accepts assignment (if you’re in a PPO, PFFS, or MSA plan and you go out-of-network).

-Whether you follow the plan’s rules, like using network providers.

-Whether you need extra benefits and if the plan charges for it.

-The plan’s yearly limit on your out-of-pocket costs for all medical services.

-Whether you have Medicaid or get help from your state.


More information can be found on the Official Government Site for Medicare: https://www.medicare.gov/your-medicare-costs/help-paying-costs/get-help-paying-costs.html

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