Medicare News: Medicare Parts A & B, How much, and what do they cover
Content
Medicare News: Parts A & B- What is the cost, and what do they cover?
BY: Dennis Stewart, Streamline Savings
HOW MUCH DOES PART A COST?
If you had to buy Part A, you will pay up to $451 each month. But, most people get premium-free Part A. You usually don’t pay a monthly premium for Medicare Part A or B coverage if you or your spouse paid Medicare taxes while working. This is sometimes called “premium-free Part A.” You can get premium-free Part A at 65 if:
You already get retirement benefits from Social Security or the Railroad Retirement Board.
You’re eligible to get Social Security or Railroad benefits but haven’t filed for them yet.
You or your spouse had Medicare-covered government employment.
If you’re under 65, you can get premium-free Part A if:
You got Social Security or Railroad Retirement Board disability benefits for 24 months.
You have End-Stage Renal Disease (ESRD) and meet certain requirements.
In most cases, if you choose to buy Part A, you must also have Medicare Part B (Medical Insurance) and pay monthly premiums for both. Some people automatically get Medicare Part A (Hospital Insurance). Learn “how” and “when” you can sign up for Part A: https://medicare.gov/sign-up-change-plans/get-parts-a-and-b/get-parts-a-and-b.html Contact Social Security for more information about the Part A premium: http://www.ssa.gov/
WHAT DOES MEDICARE PART A COVER?
Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessaryto treat a disease or condition.
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.
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
2 ways to find out if Medicare covers what you need
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.
Find out if Medicare covers your item, service, or supply.
Medicare coverage is based on 3 main factors
Federal and state laws.
National coverage decisions made by Medicare about whether something is covered.
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.
Part B- What does it cover?
Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessaryto treat a disease or condition. 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.
Part B covers 2 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 Mental health
Inpatient Outpatient Partial hospitalization
Getting a second opinion before surgery Limited outpatient prescription drugs
2 ways to find out if Medicare covers what you need
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.
Find out if Medicare covers your item, service, or supply.
Medicare coverage is based on 3 main factors
Federal and state laws.
National coverage decisions made by Medicare about whether something is covered.
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.
Ways to pay Part A & Part B premiums
If you get Social Security, Railroad Retirement Board (RRB) benefits, or Civil Service benefits, your Medicare Part B (Medical Insurance) premium will get deducted from your benefit payment. If you don't get these benefit payments and you sign up for Part B, you'll get a bill.
Medicare Savings Programs
You can get help from your state paying your Medicare premiums. In some cases, Medicare Savings Programs may also pay Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance)deductibles, coinsurance, and copayments if you meet certain conditions listed under "How to Apply."
4 kinds of Medicare Savings Programs
If you have income from working, you may qualify for these 4 programs even if your income is higher than the income limits listed below. If you qualify for a QMB, SLMB, or QI program, you automatically qualify to get Extra Help paying for Medicare prescription drug coverage. 1. Qualified Medicare Beneficiary (QMB) Program 2. Specified Low-Income Medicare Beneficiary (SLMB) Program 3. Qualifying Individual (QI) Program You must apply every year for QI benefits. QI applications are granted on a first-come, first-served basis, with priority given to people who got QI benefits the previous year. (You can't get QI benefits if you qualify for Medicaid). 4. Qualified Disabled and Working Individuals (QDWI) Program The QDWI program helps pay the Part A premium. You may qualify if any of these apply to you:
You're a working disabled person under 65 You lost your premium-free Part A when you went back to work You aren't getting medical assistance from your state You meet the income and resource limits required by your state
How to apply for Medicare Savings Programs
If you answer yes to these 3 questions, call your State Medicaid Program to see if you qualify for a Medicare Savings Program in your state: 1. Do you have, or are you eligible for, Part A? 2. Is your income for 2012 at, or below, the income limits below? 3. Do you have limited resources, below the limits below? It's important to call or fill out an application if you think you could qualify for savings—even if your income or resources are higher than the amounts listed here. Note These amounts may increase in 2013. If your income and resources are slightly higher, you should still apply.
Medicare Savings Program 2012 Income Limits
Qualified Medicare Beneficiary (QMB) Program Individual monthly income limit* $951 Married couple monthly income limit* $1281 Program helps pay for: Part A premiums Part B premiums Deductibles, coinsurance, and copayments Specified Low-Income Medicare Beneficiary (SLMB) Program Individual monthly income limit* $1137 Married couple monthly income limit* $1533 Program helps pay for: Part B premiums only Qualifying Individual (QI) Program Individual monthly income limit* $1277
Married couple monthly income limit* $1723 Program helps pay for: Part B premiums only Qualified Disabled and Working Individuals (QDWI) Program Individual monthly income limit* $3809 Married couple monthly income limit* $5129 Program helps pay for: Part A premiums only Note *Limits are slightly higher in Alaska and Hawaii. If you have income from working, you may qualify for benefits even if your income is higher than the limits listed.
Medicare Savings Program Resource Limits
Resource limits for the QMB, SLMB, and QI Medicare Savings Programs are $6,940 for one person and $10,410 for a married couple. Resource limits for the QDWI program are $4,000 for one person and $6,000 for a married couple. Countable resources include:
Money in a checking or savings account Stocks Bonds
Countable resources don't include:
Your home One car Burial plot Up to $15,000 for burial expenses if you have put that money aside Furniture Other household and personal items
How can I keep my costs down?
Make sure your Medicare card is valid and that you've paid your Part B premium. Go to a doctor, other health care provider, or supplier that acceptsassignment. Read about how to get help with medical and prescription drug costs.
Medicare also has a tool that provides the names, addresses, and contact information for suppliers that provide services or products under the Medicare program. Please
visit: http://www.medicare.gov/Supplier/Include/DataSection/Questions/SearchCriteria.asp?version=default&b rowser=Chrome%7C21%7CWindows+7&language=English&defaultstatus=0&pagelist=Home&CookiesEnab ledStatus=True For more information, please visit: www.medicare.gov
BY: Dennis Stewart, Streamline Savings
HOW MUCH DOES PART A COST?
If you had to buy Part A, you will pay up to $451 each month. But, most people get premium-free Part A. You usually don’t pay a monthly premium for Medicare Part A or B coverage if you or your spouse paid Medicare taxes while working. This is sometimes called “premium-free Part A.” You can get premium-free Part A at 65 if:
You already get retirement benefits from Social Security or the Railroad Retirement Board.
You’re eligible to get Social Security or Railroad benefits but haven’t filed for them yet.
You or your spouse had Medicare-covered government employment.
If you’re under 65, you can get premium-free Part A if:
You got Social Security or Railroad Retirement Board disability benefits for 24 months.
You have End-Stage Renal Disease (ESRD) and meet certain requirements.
In most cases, if you choose to buy Part A, you must also have Medicare Part B (Medical Insurance) and pay monthly premiums for both. Some people automatically get Medicare Part A (Hospital Insurance). Learn “how” and “when” you can sign up for Part A: https://medicare.gov/sign-up-change-plans/get-parts-a-and-b/get-parts-a-and-b.html Contact Social Security for more information about the Part A premium: http://www.ssa.gov/
WHAT DOES MEDICARE PART A COVER?
Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessaryto treat a disease or condition.
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.
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
2 ways to find out if Medicare covers what you need
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.
Find out if Medicare covers your item, service, or supply.
Medicare coverage is based on 3 main factors
Federal and state laws.
National coverage decisions made by Medicare about whether something is covered.
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.
Part B- What does it cover?
Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessaryto treat a disease or condition. 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.
Part B covers 2 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 Mental health
Inpatient Outpatient Partial hospitalization
Getting a second opinion before surgery Limited outpatient prescription drugs
2 ways to find out if Medicare covers what you need
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.
Find out if Medicare covers your item, service, or supply.
Medicare coverage is based on 3 main factors
Federal and state laws.
National coverage decisions made by Medicare about whether something is covered.
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.
Ways to pay Part A & Part B premiums
If you get Social Security, Railroad Retirement Board (RRB) benefits, or Civil Service benefits, your Medicare Part B (Medical Insurance) premium will get deducted from your benefit payment. If you don't get these benefit payments and you sign up for Part B, you'll get a bill.
Medicare Savings Programs
You can get help from your state paying your Medicare premiums. In some cases, Medicare Savings Programs may also pay Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance)deductibles, coinsurance, and copayments if you meet certain conditions listed under "How to Apply."
4 kinds of Medicare Savings Programs
If you have income from working, you may qualify for these 4 programs even if your income is higher than the income limits listed below. If you qualify for a QMB, SLMB, or QI program, you automatically qualify to get Extra Help paying for Medicare prescription drug coverage. 1. Qualified Medicare Beneficiary (QMB) Program 2. Specified Low-Income Medicare Beneficiary (SLMB) Program 3. Qualifying Individual (QI) Program You must apply every year for QI benefits. QI applications are granted on a first-come, first-served basis, with priority given to people who got QI benefits the previous year. (You can't get QI benefits if you qualify for Medicaid). 4. Qualified Disabled and Working Individuals (QDWI) Program The QDWI program helps pay the Part A premium. You may qualify if any of these apply to you:
You're a working disabled person under 65 You lost your premium-free Part A when you went back to work You aren't getting medical assistance from your state You meet the income and resource limits required by your state
How to apply for Medicare Savings Programs
If you answer yes to these 3 questions, call your State Medicaid Program to see if you qualify for a Medicare Savings Program in your state: 1. Do you have, or are you eligible for, Part A? 2. Is your income for 2012 at, or below, the income limits below? 3. Do you have limited resources, below the limits below? It's important to call or fill out an application if you think you could qualify for savings—even if your income or resources are higher than the amounts listed here. Note These amounts may increase in 2013. If your income and resources are slightly higher, you should still apply.
Medicare Savings Program 2012 Income Limits
Qualified Medicare Beneficiary (QMB) Program Individual monthly income limit* $951 Married couple monthly income limit* $1281 Program helps pay for: Part A premiums Part B premiums Deductibles, coinsurance, and copayments Specified Low-Income Medicare Beneficiary (SLMB) Program Individual monthly income limit* $1137 Married couple monthly income limit* $1533 Program helps pay for: Part B premiums only Qualifying Individual (QI) Program Individual monthly income limit* $1277
Married couple monthly income limit* $1723 Program helps pay for: Part B premiums only Qualified Disabled and Working Individuals (QDWI) Program Individual monthly income limit* $3809 Married couple monthly income limit* $5129 Program helps pay for: Part A premiums only Note *Limits are slightly higher in Alaska and Hawaii. If you have income from working, you may qualify for benefits even if your income is higher than the limits listed.
Medicare Savings Program Resource Limits
Resource limits for the QMB, SLMB, and QI Medicare Savings Programs are $6,940 for one person and $10,410 for a married couple. Resource limits for the QDWI program are $4,000 for one person and $6,000 for a married couple. Countable resources include:
Money in a checking or savings account Stocks Bonds
Countable resources don't include:
Your home One car Burial plot Up to $15,000 for burial expenses if you have put that money aside Furniture Other household and personal items
How can I keep my costs down?
Make sure your Medicare card is valid and that you've paid your Part B premium. Go to a doctor, other health care provider, or supplier that acceptsassignment. Read about how to get help with medical and prescription drug costs.
Medicare also has a tool that provides the names, addresses, and contact information for suppliers that provide services or products under the Medicare program. Please
visit: http://www.medicare.gov/Supplier/Include/DataSection/Questions/SearchCriteria.asp?version=default&b rowser=Chrome%7C21%7CWindows+7&language=English&defaultstatus=0&pagelist=Home&CookiesEnab ledStatus=True For more information, please visit: www.medicare.gov
