An Overview of Medicare

 Medicare – What Is It?

For people age 65 years and older, Medicare is a federal health insurance program. It also covers certain people with a disability or end-stage renal disease. Medicare pays for much of your health expenses, with exceptions for certain costs. These cost include items like certain home nursing care expenses and your out of pocket costs. Out of pocket costs that you must pay, like coinsurance, co-payments, and deductibles, are called “gaps” in original Medicare plan coverage.

Part A and Part B of Medicare

Part A (Hospital Insurance) helps pay for inpatient hospital care, some skilled nursing facility care, hospice care, and some home health care. Your out of pocket with Medicare Part A includes a fairly hefty deductible per benefit period and co-pays for days 61+ in the hospital. The part A benefit period is your stay in the hospital and 60 days after your get out of the hospital. So, you could conceivably have to meet multiple part A deductibles within a calendar year. The co-pays for days 61-90 is $267/day and the co-pays for days 91+ is $512/day. So, as you can see it can get rather expensive if you have multiple hospital stays or extended stays in the hospital.

Part B (Medical Insurance) helps pay for doctors’ services, outpatient hospital care, and some other medical services that Part A doesn’t cover. Part B helps pay for such covered services and supplies when they are medically necessary. The part B deductible is relatively inexpensive compared to the Part A deductible and is a calendar year deductible. However, once the deductible is met you will be responsible for 20% of your Medicare Part B-related expenses. This can also get rather expensive if you are having to undergo major medical treatment.

Will Medicare cover my medical expenses outside of the U.S.?

Persons living or traveling outside the United States usually cannot benefit from Medicare. This is because, generally speaking, the program provides protection against the cost of hospital and medical expenses incurred in the United States.

There are rare emergency cases where Medicare can pay for care for those who travel to Canada or Mexico. Also, Medicare can sometimes pay if a Canadian or Mexican hospital is closer to your home than the nearest U.S. hospital that can provide the care you need.

If you get emergency treatment in a Canadian or Mexican hospital or if you live near one, ask someone who works at the hospital about Medicare coverage, or have the hospital help you contact the Medicare Intermediary.

Health insurance protection may be very important to anyone temporarily abroad who plans to return to the United States. If you plan to return to the United States shortly after you are eligible for the medical insurance program, you may wish to enroll during your first enrollment period. If you expect to be abroad for a longer period of time, you may wish to enroll during a later general enrollment period.

What is a Medicare Approved Amount?

This is the fee that Medicare establishes with providers who accept “Medicare assignment” will charge for a covered medical service. If the doctor does not accept assignment of Medicare benefits, the Medicare approved amount may be less than the actual amount charged by a doctor or supplier for a service or supply.

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