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Medicare Coverage in 2021

It can get a bit complicated trying to learn the ins and outs of Medicare coverage. That’s why we’ve laid out some of the basics of what Medicare covers below. Read on to find out what Medicare covers and who is eligible for coverage.

What exactly does Medicare cover?

Different parts of Medicare are associated with different medical items and services. You may already be familiar with Medicare Part A hospital insurance, Part B medical insurance, and Part D prescription drug coverage, but let’s take a moment to review what each part covers.

Part A

Medicare Part A hospital insurance covers hospitalization and inpatient care coverage. It also helps with the costs of hospice and home health care, along with Skilled Nursing Facility (SNF) care. However, Medicare Part A does not pay for long-term or custodial care.

You are eligible to receive premium-free Part A coverage if you are 65 years of age or older and you or your spouse worked and paid Medicare taxes for the required amount of time. Alternatively, you qualify for premium-free Part A if you have been receiving disability benefits for 24 months or suffer from ESRD or ALS. 

If you aren’t eligible for premium-free Part A but you qualify for Medicare, you may be able to pay a premium for your Part A coverage. This amount is either $259 or $471 in 2021, depending on how long you or your spouse worked and paid Medicare taxes.

Part B

Medicare Part B medical insurance offers coverage for doctor and outpatient services. This includes certain lab tests, therapy, ambulance services, mental health treatment, and Durable Medical Equipment (DME). Medicare Part B covers both medically necessary services (diagnostics, treatments, etc.) and preventive services (screenings, certain shots, etc.). 

You must pay a monthly premium for Part B medical insurance coverage. Most beneficiaries will pay $148.50/month, though the Part B premium amount may increase for high-income beneficiaries corresponding to annual earnings. 

Part D

Medicare drug plans, or Part D, help to cover the costs of prescription medications. These plans help to pay for most prescription drugs.

Each Medicare Part D plan has its own formulary, which is a list of which drugs the plan covers. Plans cover both brand-name prescription drugs and generic drugs, and every Part D plan’s drug list must cover at least two medications per drug category.

Additionally, there are six protected classes in which the majority of corresponding medications must be covered: antipsychotics, antidepressants, anticonvulsants, immunosuppressants, cancer drugs, and HIV/AIDS drugs. 

But Medicare Part D plans are not required to cover certain types of medications, such as weight loss/gain drugs, erectile dysfunction medications, and over-the-counter drugs.

What is not covered by Medicare?

What is Medicare?Original Medicare coverage is broad, but it doesn’t pay for every health-related service that you might require. Medicare doesn’t cover long-term (custodial) care, the majority of dental care, eye exams, cosmetic procedures, acupuncture, routine foot care, dentures, or hearing aids. 

With Original Medicare, you will also be responsible for paying for the costs of your deductibles, copayments, coinsurance, and other health care costs. However, you can enroll in Medicare Supplement Insurance or a Medicare Advantage plan if you would like to broaden your coverage benefits.

Medicare Supplement Insurance

One additional coverage option many Medicare beneficiaries have is to purchase Medicare Supplement Insurance. Also called Medigap, these plans work by “filling in the health care coverage gaps” left over by Original Medicare. These benefits can include coverage for your deductibles, coinsurance, copays, Part B excess charges, and more.

People enrolled in Medigap insurance still have to pay for their Part B and Part D premiums, if applicable. And though Medicare Supplement plans come with their own premiums, they can help to pay for unexpected expenses that you would be responsible for covering should you just have coverage through Original Medicare.

Medicare Advantage

Another alternative to Original Medicare is Medicare Advantage, or Part C. A Medicare Advantage Plan is a good option for those who are looking for more coverage than what you would get with Original Medicare. 

A Medicare Advantage plan works by replacing Original Medicare (Part A and Part B) coverage. These plans can offer additional benefits such as dental care, hearing, vision, health and wellness programs, prescription drug coverage, and more.

If you would like to discuss your Medigap or Medicare Advantage plan options, sign up for a free call about Medicare options with a team member here at Medicare Plans Direct today.

Who does Medicare cover?

Most people become eligible for Medicare when they turn 65. The only requirements are that you be a U.S. citizen or legal resident who has lived in the United States for at least five consecutive years. 

If you or your spouse worked and paid Medicare taxes for at least 10 years, or if you are receiving/are eligible to receive Social Security or Railroad Retirement Board (RRB) benefits, you are eligible to receive premium-free Part A. 

If you don’t receive Part A at no cost, you may be able to pay for it. This means that when you turn 65, even if you aren’t receiving Social Security/RRB benefits or haven’t paid the required amount of Medicare taxes, you can pay a monthly premium for Part A hospital and inpatient coverage. 

Additionally, when you turn 65, you can enroll in Medicare Part B. Everyone, regardless of whether or not you are eligible for coverage under premium-free Part A, must pay a monthly Part B premium.

Disability, ALS, and ESRD Medicare Coverage

If you have been receiving disability benefits through Social Security or the RRB for 24 months, you will automatically be enrolled Medicare on your 25th month of benefits. If you suffer from Lou Gherig’s disease (ALS), you qualify for Medicare the first month that you are eligible for disability benefits. 

Additionally, Medicare covers people who suffer from ESRD (End-Stage Renal Disease). These are individuals who  have undergone a kidney transplant or require dialysis.

How can I find out if I am eligible for Medicare coverage?

In most cases, knowing whether or not you can receive Medicare coverage is quite straightforward. However, if you have any doubts regarding your Medicare eligibility, reach one of our team members today.

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