What Does Original Medicare Cover?

Medicare can be complex due to all the various parts of Medicare and options for additional coverages. 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 and related hospital charges.

Part A is free of charge when signing up for your Social Security for those that have paid into applicable taxes throughout their life. However, if there is an intentional delay in receiving Social Security benefits, one can still receive Part A.  Those who are currently insured under an employer’s plan you should still look into signing up for Part A when turning 65.   For every year delayed in signing up for Part A, 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

Under this plan, the insured is allowed to see any provider that accepts Medicare. This coverage includes doctor visits and other health care providers, as well as durable medical equipment and home health. Some preventive services are included to help maintain a healthy life and prevent certain illnesses from getting worse.

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.

Does Original Medicare Cover Dental Services?

Original Medicare does not cover Dental, unless you have an associated ailment like Neoplastic disease, kidney transplantation, heart valve replacement, or are undergoing reconstruction of the jaw due to an accidental injury.

For more comprehensive dental coverage for preventative procedures such as cleanings and x-rays, fillings, dentures, etc. please talk to your insurance agent about options for coverage from a Medicare Advantage Plan.

Does Original Medicare Cover Vision Services?

Individual vision plans are also available for purchase. If you enroll in a Medicare Advantage Plan vision is often included in your plan for no additional cost.  Talk to your insurance agent to learn more.

Does Original Medicare Cover Hearing Aids?

Medicare supplement plans do not include hearing benefits, but Medicare Advantage plans often include hearing benefits such as exams, fittings and discounted prices on hearing aids.

Check with your insurance agent to review your needs and additional coverage options available.

Does Medicare Cover Home Health Services?

Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medicare Insurance) covers eligible home health services like these:

Part-time or “intermittent” skilled nursing care

Physical therapy

Occupational therapy

Speech-language pathology services

Medical social services

Part-time or intermittent home health aide care (only if you’re also getting other skilled services like nursing and/or therapy at the same time)

Injectable osteoporosis drugs for women

Durable medical equipment

Medical supplies for use at home

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.

Medicare doesn’t pay for:

24-hour-a-day care at your home

Meals delivered to your home

Homemaker services (like shopping, cleaning, and laundry) that aren’t related to your care plan

Custodial or personal care that helps you with daily activities (like bathing, dressing, or using the bathroom), when this is the only care you need.

Does Medicare Cover Prescription Drugs?

Original Medicare also does not cover Prescription Drugs, nor do Medicare Supplement Plans. Stand-alone Part D plans are available as well as Medicare Advantage Plans that can 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” (also called the “base beneficiary premium”) 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.

The base beneficiary premium for 2023 is $32.74. This amount may change each year, so the penalty amount can also change each year. Medicare uses the current coverage year’s base beneficiary premium to calculate the penalty amount.

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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