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Medicare

Medicare is government health insurance for those aged 65 and older or for those with disabilities. People can enroll in either Original Medicare or a Medicare Advantage Plan. Medicare is different from private insurance — it doesn’t offer plans for couples or families.

 

Original Medicare

  • Part A Hospital Coverage is usually free to individuals and their spouses who have worked for 10 years, although there is a deductible. Part B covers non-hospital medical expenses and has a premium.  Learn more about  Part A and B costs and coverage .

  • Part D is the optional prescription drug benefit.

  • Individuals can see any medical provider who accepts Medicare

 

Medicare Advantage Plans (MA Plans) also known as Part C

  • MA Plans include Part A and B and usually include prescription drug plans. They may also include other supplemental services such as dental, vision, transportation, meals and other supportive services.  

  • MA plans are often less expensive than Original Medicare; however, individuals must see providers within the plan’s network. 

 

Medicare Savings Plans (MSP) 

MSPs can assist with covering the cost of Medicare premiums and copays. MSPs are administered by each state under their Medicaid program. Medicaid eligibility by state

 

Enrollment

  • Generally, people are eligible to enroll in Medicare the 3 months before or after their 65th birthday. 

  • If someone does not enroll during their eligibility period, they will incur penalty fees. 

  • Open enrollment is from October 15th to December 7th each year.  This is the time when people can change plans or add a drug plan. There is no need to re-enroll in Part A or B. 

 

Understanding your Medicare Plan or Choosing a New Plan

The  State Health Insurance Assistance Program provides unbiased individual counseling and assistance and can assist with choosing a new plan (including a drug plan), as well as understanding Medicare benefits and out-of-pocket costs.

 

What Does Medicare Cover?

Medicare covers health care services, treatment, hospice care, and equipment that are considered medically-necessary. It will pay for short-term medical care (home health) in the home when ordered by a medical provider and rehabilitation stays. It does not cover non-medical in-home care, long-term skilled nursing facilities, or assisted living. 

 

Appeals

If a person disagrees with a coverage or payment decision, they have the right to appeal. The process varies depending on the specific plan:  How To File an Appeal.

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