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FAQs for Original Medicare, Medicare Advantage, and Medicare Supplement

What is Original Medicare?


Original Medicare consists of two parts. Part A (hospital insurance) and Part B (Medical Insurance). It does not include Part D (prescription drug coverage).




What does Medicare Part A cost?


You usually do not pay a monthly premium for Medicare Part A (Hospital Insurance) coverage. You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. If you must buy Part A, you will pay up to $458 each month in 2020. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $458. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $252.
If you must buy Part A, and you do not buy it when you are first eligible, your monthly premium may go up 10%. (You'll have to pay the higher premium for twice the number of years you could have had Part A but did not sign up.)




What does Medicare Part A cover?


In general, and within Medicare guidelines, Part A covers: Inpatient care in a hospital, Skilled nursing facility care (following a qualifying hospital stay), Nursing home care (inpatient care in a skilled nursing facility, not custodial or long-term care), Hospice care and Home health care. Always consider, it must be medically necessary.




What are the Medicare Part A deductibles and coinsurance amounts?


For 2020 you pay: Inpatient care in hospitals

  • $1,408 deductible for each benefit period
  • Days 1-60: $0 coinsurance for each benefit period
  • Days 61-90: $352 coinsurance per day of each benefit period
  • Days 91 and beyond: $704 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime)
  • Beyond lifetime reserve days: all costs
Skilled nursing facility care
  • Per day Days 1-20: $0
  • Per day Days 21-100: $176/ day
Hospice care
  • $0 for hospice care.
  • You may need to pay a copayment of no more than $5 for each prescription drug and other similar products for pain relief and symptom control while you are at home. In the rare case your drug is not covered by the hospice benefit, your hospice provider should contact your Medicare drug plan to see if it is covered under Medicare prescription drug coverage (Part D)
  • You may need to pay 5% of the Medicare-approved amount for inpatient respite care.
  • Medicare does not cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).
Home health care
  • $0 for home health care services.
  • 20% of the Medicare-approved amount for Durable medical equipment (DME)




What does Medicare Part B cost?


You pay a premium each month for Part B. The standard Part B premium amount in 2020 is $144.60. Most people pay the standard Part B premium amount. If your modified adjusted gross income is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium. In most cases, if you do not sign up for Part B when you are first eligible, you will have to pay a late enrollment penalty. You will have to pay this penalty for as long as you have Part B. Your monthly premium for Part B may go up 10% of the standard premium for each full 12-month period that you could have had Part B but did not sign up for it. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B. Coverage will start July 1 of that year.




What does Medicare Part B cover?


In general, and within Medicare guidelines, Part B covers most doctor services, emergency or observation services, ambulance services, outpatient services, clinical research, durable medical equipment (DME) and limited Mental health. Medicare Part B classifies and covers two 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 or detect it at an early stage when treatment is most likely to work best.




What are the Medicare Part B deductibles and coinsurance amounts?


In 2020, you pay $198 for your Part B deductible. After you meet your deductible for the year, you typically pay 20% coinsurance on the Medicare-approved amount for covered services. You typically pay nothing for most covered preventive services if you get the services from a health care provider who accepts assignment.




What are my choices for coverage beyond Original Medicare?


A Supplement Plan (Medigap), an Advantage Plan (Part C), or a Medicare Medical Savings Account (MSA) Plan. You can choose to purchase one, but not more than one. In limited areas of Minnesota, you may have the option of selecting a Cost Plan.




What is a Supplement Plan (Medigap)?


A supplement plan is a health insurance plan offered by private insurance companies. Coverage of this type is designed to supplement Medicare by covering some hospital, medical and surgical services which are partially covered by Medicare but does not cover all medical expenses beyond those covered by Medicare.




What is an Advantage Plan (Part C)?


An Advantage plan is an “all in one” alternative to Original Medicare. It is provided by private insurance companies contracted with Medicare to provide all your Part A and Part B benefits. Many Medicare Advantage Plans also offer prescription drug coverage as well as extra coverage, like routine vision, hearing and dental coverage. Most Medicare services are covered through the Advantage plan. Your Medicare services are not paid for by Original Medicare, but you still have Medicare. Medicare pays a fixed amount for your care each month to these companies and they must follow rules set by Medicare. Each Medicare Advantage Plan can charge different out-of-pocket costs. They can also have different rules for how you get services, like whether you need a referral or if you need to stay in their network for care. What you pay for services depends on several factors and these amounts can be different than what you would pay under Original Medicare. Be sure to review the plan’s Summary of Benefits carefully to know what the plan rules are and what your costs will be.




What is a Medicare Medical Savings Account (MSA) Plan?


An MSA plan is provided by private insurance companies contracted with Medicare to offer a consumer-directed Medicare Advantage Plan, called a Medicare MSA Plan. These plans are like Health Savings Account Plans available outside of Medicare. You choose your health care services and providers. Medicare MSA Plans combine a high-deductible insurance plan with a medical savings account that you can use to pay for your health care costs. Medicare MSA Plans do not cover Medicare Part D prescription drugs. The two parts of MSA plans include:

  1. High-deductible health plan: The first part is a special type of high-deductible Medicare Advantage Plan (Part C). The plan will only begin to cover your costs once you meet a high yearly deductible, which varies by plan.
  2. Medical Savings Account (MSA): The second part is a special type of savings account. The Medicare MSA Plan deposits money into your account. You can use money from this savings account to pay your health care costs before you meet the deductible.




What is a Cost Plan?


Cost Plans are Medicare health plans that provide health care coverage that are not Medicare Advantage Plans but are still part of Medicare.




How can I find out if my test, service, or procedure is covered by Original Medicare?


There are two ways to find out.

  1. Talk to your doctor/ health care provider
  2. Go to https://www.medicare.gov/coverage.




How can I find out if my test, service, or procedure is covered by my Advantage plan?


There are three ways to find out.

  1. Talk to your doctor/ health care provider
  2. Talk to your plan’s Member Services department. Obtaining prior authorization or a pre-determination of benefits is advised.
  3. Review your plan’s Evidence of Coverage (EOC) document. The EOC is the most comprehensive document that describes in detail the health care benefits covered by your health plan. It provides documentation of what that plan covers and how it works, including how much you pay.




How can I find out if my test, service, or procedure is covered by my Supplement plan?


Coverage of this type is designed to supplement Medicare by covering some hospital, medical and surgical services which are partially covered by Medicare but does not cover all medical expenses beyond those covered by Medicare. To determine if your test, services, or procedure is covered by Medicare there are two ways to find out.

  1. Talk to your doctor/ health care provider
  2. Go to https://www.medicare.gov/coverage.
To then determine how your Medicare covered test, service, or procedure is covered by your Supplement plan, refer to your policy’s Outline of Coverage or contact your plan’s member services department. To determine if your test, service, or procedure which is not covered by Medicare but may be covered by your Supplement plan, refer to your policy’s Outline of Coverage or contact your plan’s member services department.




How do I pay my Medicare premium?


If you receive Social Security or Railroad Retirement Board (RRB) benefits, your Part B (Medical Insurance) premium will get deducted automatically from your benefit payment. If you do not receive these benefits, you will get a bill to pay your premiums. You then have four options to pay:

  1. Pay online through your secure Medicare account — You can pay by credit card, debit card, or from your checking or savings account.
  2. Pay directly from your savings or checking account through your bank's online bill payment service, learn what information you need to have ready when you contact your bank to set up this service.
  3. Sign up for Medicare Easy Pay, a free service that automatically deducts your premium payments from your savings or checking account each month. Your premium from your bank account will usually be deducted on the 20th of the month.
  4. Mail your payment to Medicare — You can pay by check, money order, credit card, or debit card. Fill out the payment coupon that comes with your bill. Payments sent without the coupon may be delayed. If you pay by credit/debit card, enter the account information and expiration date as it appears on your card. Be sure to sign the coupon.
Mail your Medicare payment coupon and payment to: Medicare Premium Collection Center PO Box 790355 St. Louis, MO 63179-0355




How often will I get a Medicare bill?


If you pay for only Part B, you will get a "Medicare Premium Bill" (Form CMS-500) every 3 months. If you pay for (buy) Part A or if you owe Part D IRMAA (Income Related Monthly Adjustment Amount), you will receive a “Medicare Premium Bill” every month.




What is Medicare Easy Pay?


Medicare Easy Pay is a free, electronic payment option that lets you have Medicare premium payments automatically deducted from a savings or checking account each month.




Can I sign up for Medicare Easy Pay online?


Sign up for Medicare Easy Pay, which is a free, electronic payment option that automatically deducts premium payments from your savings or checking account each month it is due. To sign up, go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227; TTY users, call 1-877-486-2048).




Which Medicare plans cover hearing aids?


Original Medicare does not cover hearing aids or exams for fitting hearing aids. Some Medicare Advantage Plans (Part C) offer extra benefits that Original Medicare does not cover - like vision, hearing, or dental.




Which Medicare plans cover eye exams?


Original Medicare does not cover eye exams (sometimes called “eye refractions”) for eyeglasses or contact lenses. Some Medicare Advantage Plans (Part C) offer extra benefits that Original Medicare does not cover - like vision, hearing, or dental.




Which Medicare plans cover dental?


Original Medicare does not cover most dental care, dental procedures, or supplies, like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices. Medicare Part A (Hospital Insurance) will pay for certain dental services that you get when you are in a hospital. Part A can pay for inpatient hospital care if you need to have emergency or complicated dental procedures, even though the dental care is not covered. Inpatient care includes treatment you get in an acute care hospital, critical access hospital, inpatient rehabilitation facility, long-term care hospital, inpatient care as part of a qualifying research study, and mental health care. Some Medicare Advantage Plans (Part C) offer extra benefits that Original Medicare does not cover - like vision, hearing, or dental.




When does Medicare begin?


Medicare begins the first day of the month you turn 65. If your birthday falls on the first day of the month, Medicare will begin on the first day of the month the month prior to your 65th birthday. If you are under 65 and have a disability, you automatically get Part A and Part B after you receive disability benefits from Social Security for 24 months.




Who is eligible for Medicare?


Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).





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