How is Medicare Different from Other Health Insurance?

You may be surprised at the differences between Medicare and other types of health insurance. If you’ve had health coverage in the past through your employer, your plan likely included medical and prescription drug coverage, along with other benefits. It also may have covered both you and your spouse.
Medicare only covers one person at a time. This means you and your spouse must enroll separately. In addition, Medicare gives you options that can make it possible to receive your benefits in a variety of different ways.
You can choose among these different options:
  • Hospital and Medical Coverage:Provided by the federal government.
  • Prescription Drug Coverage: Offered by a private company.
  • Supplemental Insurance: Purchase from a private insurer to cover additional costs.
  • All-Inclusive Plans: Private insurers offer combined hospital, medical, and prescription drug coverage.
In short, with Medicare you can choose the type of coverage that fits your needs, budget and lifestyle. We will help you take full advantage of that freedom.
How to understand Medicare coverage
Don’t see what you need? Send me an email, Kathi@WhenIam65.com. Tell me what you are looking for and I will help you.

Medicare Part A, Hospital Insurance

What’s covered?
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 your Original Medicare. Please note that some services may only be covered in certain settings or for patients with specific conditions.

In general, Part A covers:

Two ways to find out if Medicare covers what you need
Talk to your doctor or other health care providers 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
  1. Federal and state laws.
  2. National coverage decisions made by Medicare about whether something is covered.
  3. Local coverage decisions are 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.

Medicare Part B, Physician Services

What’s covered?
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.
Part B 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 (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:

There are two ways to find out if Medicare covers what you need:
  1. Consult Your Doctor: Discuss your needs with your healthcare provider and inquire about Medicare coverage. 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.
  2. Verify Coverage: Find out if Medicare covers your required item, service, or supply. Tap here to Find out if Medicare covers your item, service, or supply.

Medicare coverage is based on 3 main factors:

  1. Federal and state laws
  2. National Medicare coverage decisions
  3. Local coverage decisions by state-based claims processors.
Have more questions? Give me a call at 317-203-8438, or book a time on my calendar.
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