Medicare is the Government health insurance program for people age 65 and above, people under age 65 with disabilities and people with End-Stage Renal Disease (ESRD).
Medicare covers various services, like hospital stays, doctor visits, supplies like blood glucose test strips as well as Prescription drug .
Medicare program has different parts under which different services and supplies are covered, which are outlined below. Medicare does not cover everything and for many covered services you pay a portion of the cost, unless you have another insurance plan that pays for part or all of the patient cost-sharing. Some information regarding Medicare Part A, Part B, Part D, Medicare Advantage and Medigap is given below.
To learn more , call 1-800-MEDICARE (800-633-4227) or visit www.medicare.gov.
There are 2 main ways to get Medicare coverage—Original Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C).
Medicare Part A
Medicare Part A (hospital insurance) provides coverage for medically hospital stays, nursing facilities etc
How Much Does it Cost?
Most people do not have to pay a monthly premium for Medicare Part A because they or a spouse paid Medicare taxes while working. If you do not qualify for premium-free Part A, you may be able to purchase the coverage. Check with your local Social Security office, or call 1-800-772-1213 for more information about buying Medicare Part A coverage.
If you aren’t eligible for premium-free Part A, and you don’t buy it when you’re first eligible, you may have to pay a late enrollment penalty. Contact Medicare at 1-800-MEDICARE (800-633-4227) for more information.
For services you use under Part A, you may be charged a deductible and/or portion of the costs. In 2016, the Part A deductible is $1,288 per benefit period ($1,316 in 2017) and depending on the length of your hospital stay you may pay additional coinsurance.
For More information on Part A costs and covered benefits visit www.medicare.gov or call 1-800-MEDICARE (800-633-4227).
Medicare Part B
Medicare Part B covers doctors’ services, outpatient care, durable medical equipment, lab tests, preventive care and some medically necessary services not covered by Part A (including some physical and occupational therapy services and some home health care).
Medicare Part B covers blood glucose monitors, blood glucose test strips, lancet devices, lancets, and glucose control solutions for beneficiaries with diabetes, whether or not they use insulin, but the amount covered varies.
Beneficiaries with diabetes who use insulin may be able to get up to 300 test strips and 300 lancets every three months. Beneficiaries with diabetes who don’t use insulin may be able to get up to 100 test strips and 100 lancets every three months.
Medicare Part B covers insulin pumps and pump supplies (including the insulin used in the pump) for beneficiaries with diabetes who meet certain requirements. From January 1, 2014 until December 31, 2016, insulin pumps and pump supplies (but not insulin) are included in the Medicare Competitive Bidding Program in 9 areas of the U.S. This means beneficiaries in these 9 areas with Original Medicare (not Medicare Advantage) generally must use a Medicare contract supplier for Medicare to help pay for these items. After December 31, 2016, insulin pumps and pump supplies will no longer be part of the Medicare Competitive Bidding Program which means people in these 9 areas can use any Medicare supplier that provides insulin pumps and supplies.
Preventive care covered by Part B, includes diagnostic screenings for diabetes and cardiovascular disease, obesity screening and counseling, and glaucoma tests.
Medical nutrition therapy and diabetes self-management training are also covered . In some case therapeutic shoes are also covered.
A “Welcome to Medicare” free of cost physical exam is done in the first 12 months of Part B coverage.
Thereafter an “Annual Wellness Visit,” is done where the creation (or update) of a personalized prevention plan, is done every 12 months after the first 12 months of Part B coverage or after receiving a Welcome to Medicare physical exam.
How Much Does It Cost?
Part B coverage requires a monthly premium. This premium can change from year to year. In 2016, most people had a monthly Part B premium of $104.90, although if your income is above a certain amount you may pay more. The Social Security Administration can verify the exact amount of your monthly premium.
It is not compulsory to enroll in Medicare Part B. However, if you decline to enroll when you are first eligible, and then get it later, you may have to pay extra for the coverage. Your monthly premium may increase by 10 percent for each 12 month period that you could have had Part B but did not sign up for it. You may have to pay this late enrollment penalty for as long as you have Part B, unless you meet certain conditions.
More information on Part B costs and benefits is available at www.medicare.gov or by calling 1-800-MEDICARE (800-633-4227).
Medicare Part C
Some choose Medicare Advantage plans instead of Medicare Part A and B (the “Original Medicare Plan”).
A Medicare Advantage Plan is a type of Medicare health plan offered by a private insurance company that contracts with Medicare to provide you with all your Part A and Part B benefits.
Because Medicare Advantage plans are private insurance plans, they come in with different options. Out-of-pocket costs vary . Most plans offer prescription drug coverage and plans may offer extra benefits that are not covered under Parts A and B (but you may pay extra for them).
How Much Does it Cost?
Medicare Advantage plans can charge different premiums and have different rules for how beneficiaries access services, such as you must go to only doctors, facilities or suppliers that belong to the plan for non-emergency care.
In addition to the Part B premium, Medicare Advantage plan enrollees usually pay a monthly premium for the plan.
People who have Medicare Parts A & B are generally eligible for Medicare Advantage if they live in the service area of the plan they want to join.
To learn more about Medicare Advantage plans, including when you can join a plan or change plans, visit www.medicare.gov or call 1-800-MEDICARE (800-633-4227).
Medicare Part D
Medicare Part D is a program for prescription drug available to all Medicare beneficiaries. Here you choose a Prescription Drug Plan run by a private insurance company which is approved by Medicare. Note: Most Medicare Advantage plans offer prescription drug coverage so some beneficiaries with a Medicare Advantage plan may get drug coverage that way instead.
Part D coverage is optional and you are not required to sign up for it. But, if you choose not to join a Medicare Prescription Drug Plan when you are first eligible, and you don’t have other creditable prescription drug coverage, you may have to pay a late enrollment penalty if you decide to sign up in the future. [Note: Medicare Part B does not generally cover prescription drugs, aside from those administered by a physician and insulin used in an insulin pump].
Each Medicare Prescription Drug Plan has its own list of covered drugs . Many plans place drugs into different “tiers” on their formularies. Drugs in each tier have a different cost.
Medicare drug plans cover insulin not used in an insulin pump and can cover other drugs necessary to treat diabetes. In addition to providing prescription drug coverage, Medicare Part D plans may cover supplies necessary to inject insulin, including syringes, needles, alcohol swabs and gauze. Check the formulary to see which drugs and supplies are covered by each plan and how much it will cost you to get them.
Compare Part D plans to see how well they will serve your needs. You can make a chart for yourself comparing what you will pay under each plan you are interested in. When choosing a Part D plan, make sure that the plan formulary includes all of the drugs you take (including your insulin and other diabetes medications) and the insulin injection supplies you need, and ask if there are any limits. Also make sure the pharmacies you like to use are included in the plan network.
How Much Does it Cost?
Most Medicare drug plans charge a monthly premium that varies by plan (separate from the Part B premium you may already be paying), plus some out-of-pocket expenses for your medications.
Most drug plans also have a deductible that you must first pay before the plan begins to pay its share of covered drugs. When comparing plans, consider the cost of the deductible plus the cost of each drug you need, and ask if there are any limits. Compare Part D plans to find the plan that is right for you.
Most Medicare drug plans have a coverage gap (also called a donut hole). This means after you and your drug plan have spent a certain amount for covered drugs, in 2016, you are responsible for paying 45% of the plan’s cost for covered brand name prescription drugs and 58% of the cost for generic drugs while you are in the coverage gap. In 2017, you are responsible for paying 40% of the plan’s cost for covered brand name prescription drugs and 51% of the cost for generic drugs while you are in the coverage gap.
As a result of the Affordable Care Act, additional savings will occur each year for people in the coverage gap through 2020, when the gap will not exist anymore.
In 2016, once you have spent a total of $4,850 out-of-pocket ($4,950 in 2017), you will come out of the coverage gap. This includes what’s spent before and during the coverage gap. Once you are out of the coverage gap, you will automatically have “catastrophic coverage.” This means you will only pay a small amount for covered drugs for the rest of the year. Contact Medicare or your prescription drug plan to learn more.