Medicare can be complex due to all the various parts of Medicare and options for additional coverage. Let’s explore what Original Medicare Cover and what it does not. Original Medicare contains two parts. Part A for hospital charges and Part B for doctor visits.
Medicare Part A
Medicare Part A is coverage for hospitalization, skilled nursing facilities, hospice and home health care.
Part A has no premium to individuals who have worked and paid Medicare taxes for at least 40 quarters or 10 years of your life. Those who remain insured under an employer’s plan after their 65th birthday should still look into signing up for Part A when turning 65. For every year delayed in signing up for Part A when eligible, a penalty will be assessed and added to the premium each month, for the rest of your life. One can sign up for Part A starting 90 days prior to their 65th birthday.
Medicare Part B
Medicare part B is coverage for doctor visits, Lab work, x-rays & scans, and durable medical equipment.
Part B has a monthly premium based on your income that can be withdrawn from your social security benefits. The insured is allowed to see any provider that accepts Medicare. Some preventive services are included to help maintain a healthy life and prevent certain illnesses.
Still working and covered under an employer’s health insurance plan? It could still benefit you to check out Medicare. Often Medicare can provide more coverage for less premium and overall out-of-pocket expense. How much you could save can only be known by pricing out Medicare plans versus the employer’s plan. Turning 65 is an excellent time to shop for the right health plan to meet your needs.
What Does Original Medicare Not Cover?
Does Original Medicare Cover Dental Services?
Original Medicare does not cover Dental, unless medically necessary. Should you choose a supplement plan with original Medicare, you may buy an individual dental plan for coverage. Should you choose an advantage plan, preventative dental may be included with an option to “buy up” for comprehensive coverage at an additional cost.
Does Original Medicare Cover Vision Services?
Original Medicare does not cover vision services. However, individual vision plans are also available for purchase if you choose a supplement plan. If you enroll in a Medicare Advantage Plan, preventative vision services are often included in your plan for no additional cost.
Does Original Medicare Cover Hearing Aids?
Original Medicare does not include hearing benefits. However, Medicare Advantage plans often include preventative hearing benefits such as exams, fittings, and discounted prices on hearing aids.
Does Medicare Cover Home Health Services?
Original Medicare does cover home health services. To be eligible for coverage, your doctor must certify that you are homebound and in need of services such as intermittent skilled nursing care, physical therapy, occupational therapy, and speech-language pathology services to name a few.
Usually, a home health care agency coordinates the services your doctor orders for you. The home health agency caring for you must be Medicare-certified.
Services such as 24-hour-a-day care at your home, homemaker services (like shopping, cleaning, and laundry), custodial or personal care that helps you with daily activities (like bathing, dressing, or using the bathroom) are not eligible for coverage as home health.
Does Medicare Cover Prescription Drugs?
Original Medicare does not cover prescription drug coverage (or part D plans). Stand-alone Part D plans are available if you choose a supplement plan to accompany your original Medicare services. If you choose a Medicare Advantage Plan, that plan may include prescription drug coverage for no additional cost. For Medicare Part D it’s important to understand the Part D Penalty.
What is the Medicare Part D Penalty?
The late enrollment penalty (also called the “LEP” or “penalty”) is an amount that may be permanently added to a person’s monthly premium for Medicare drug coverage (Part D). A person may owe a late enrollment penalty if, after their Initial Enrollment Period, they go without Part D or other creditable prescription drug coverage for any period of 63 days or more in a row. Generally, the late enrollment penalty is added to the person’s monthly Part D premium for as long as they have Medicare drug coverage, even if the person changes their Medicare plan. This also means that if a person joins a plan that has a $0 monthly premium, they’ll still owe a penalty. The late enrollment penalty amount changes each year. The cost of the late enrollment penalty depends on how long the person went without Part D or other creditable prescription drug coverage.
How’s the Late Enrollment Penalty Calculated?
Medicare calculates the penalty by multiplying 1% of the national base beneficiary premium ($32.74) times the number of full, uncovered months the person didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to their monthly Part D premium.
.24 (24 months) x $32.74 (base premium rate) = $8 (penalty)
Where Can You Learn More About What Medicare Covers?
Visit Medicare.gov/coverage to see if your test, item or service is covered. You can also talk with your doctor or other health care provider about why you need the item or service, and they can help you understand if Medicare will cover it.
Bancorp Insurance Agency works with a variety of leading carriers in Oregon to provide you with the best options for Medicare Advantage and Medicare Supplement Plans. Bancorp’s insurance agents are available to provide you with a free review and consultation. Contact Us – Bancorp Insurance Call 800-452-6826
Disclaimer: This content is provided for general information purposes and is not intended to be used in place of consultation with our agents.
Sourced January 30, 2023 from Learning What Medicare Covers & Your Costs. Hearing Aid Coverage (medicare.gov), Wheelchair Insurance Coverage (medicare.gov), Home Health Services Coverage (medicare.gov), Medicare Dental Coverage | CMS
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