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Medicare

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Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessary to 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.

Medicare is funded through two trust accounts held by the U.S. Treasury:

  • Hospital Insurance Trust Fund which pays for:
    • Medicare Part A:
      • 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
  • Supplementary Medical Insurance Trust Fund which pays for:
    • Medicare Part B:
      • 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 (DME)
        • Mental Health
          • Inpatient
          • Outpatient
        • Partial hospitalization
        • Getting a second opinion before surgery
        • Limited outpatient prescription drugs
    • Medicare Part D:
      • Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to join a Medicare Prescription Drug Plan when you’re first eligible, and you don’t have other creditable prescription drug coverage, or you don’t get Extra Help, you’ll likely pay a late enrollment penalty.  To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.

For more information on Medicare visit Medicare.gov The Official U.S. Government Site for Medicare or contact your Care Coordinator.

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