Medicare for You: What You Need to Know
Reading Time: 2 MinutesLast Updated: April 6, 2023
We invited the Administrator to share helpful information on Medicare coverage. This is part 1 in the two-part series.
Your health is important and needs to be protected. If you are 65 or older, or have certain disabilities, or End-Stage Renal Disease, you can get health care coverage through the Medicare program. You’ll get access to health care services you need to achieve and maintain good health.
It’s important to review your Medicare coverage options and find an affordable option that meets your health care needs.
Medicare coverage options
There are two types of Medicare coverage:
- Traditional or Original Medicare.
- Medicare Advantage.
Original Medicare helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. It also covers:
- Services from doctors and other health care providers.
- Outpatient care.
- Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment).
- Preventive services (like screenings, certain vaccines, and annual wellness visits).
Original Medicare is often referred to as Part A and Part B. You can go to any doctor or hospital, anywhere in the United States, that accepts Medicare. If you have Original Medicare, you can also buy a Medicare Supplement Insurance (Medigap) policy from a private insurance company. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medigap policy can help pay some of the remaining health care costs, such as copayments, coinsurance, and deductibles.
Medicare Advantage bundles your Original Medicare – and usually Medicare prescription drug coverage – into one health insurance plan. If you select Medicare Advantage coverage, you join a plan offered by Medicare-approved private companies.
Each plan can have different rules for how you get services – like referrals to see a specialist. All plans must cover emergency and urgent care, as well as all medically necessary services covered by Original Medicare.
In many cases, you can only use doctors and other providers who are in your plan’s network and service area. Costs for monthly premiums and services vary depending on which plan you join. Some plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.
Whether you choose Original Medicare or Medicare Advantage, be sure you have prescription drug coverage. You can join a Medicare Prescription Drug Plan (called a PDP) in addition to Original Medicare. You can also get it by joining a Medicare Advantage plan with Medicare prescription drug coverage.
Please visit Medicare.gov to learn more about the difference between Original Medicare and Medicare Advantage. With the Medicare Plan Finder, you can see comparisons of costs and coverage for Original Medicare, Medicare Advantage, and Medicare drug plans.
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Tags: General Information, Medicare
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Leonard R.
Dear Ann C., As read your relies “Contact Your local office.” My question is, “What do the federal offices provide to me?”
REP
If I understand it correctly, Medicare premiums are based upon tax filings. I became a widow in September of 2021, and lost an almost six-figure salary. My premiums for Medicare increased by sixty dollars instead of decreasing. Can anyone explain this to me? This year, my tax filing was based upon my income only. Will the premium deducted from my Social Security income decrease?
Shirley L.
I remarried 2 years ago. I went to the Social Security office and got my name changed. The problem is: Whoever signed me up for Medicare did not get my name changed to my married name added to my Medicare card part A since I a still working. Social Security tells me I am signed up for Medicare, yet Medicare says I am not. Medicare says contact Social Security to fixe the matter. Medicare has nothing in my married name. They still have my old name. I get mails from SS saying I am enrolled and giving my Medicare number. Something is wrong.
A.C.
Hi, Shirley. We are sorry to hear that. Please contact your local Social Security office for assistance. Thanks!
parmay
Like Russ M., I want to know whether retired military in Tricare for Life, who are required to sign up for Medicare A & B, will get similar protection as with a Medigap plan. Since these are both US government programs, it seems that someone in the government should be able to answer this question in some detail.
Judith M.
I too am interested in this answer. It would be very helpful for many us.
Karen K.
Why does Medicare not pay for diabetic items like the strips, finger pokers, and if using an insulin pen the pen tips? You can NOT have one without the other. That makes NO SENSE!!
Patricia C.
How can I get medicaid too? Almost all of my teeth are gone due to 3 botched root canals 2019, covid 2021, vaccines 2021-2022.
I need implants, extractions, fillings; I had maybe 3 missing teeth prior to 2019.
I haven’t had a life since 2021, lost out on 3 interviews, 2 offers, boyfriend left me.
I am 59, disabled permanently but I am a college student now since January, loans and grants and I want the chance to get better and by some miracle work again.
I can’t live on SSDI until I die, I just can’t.
I have no emergency contact, no friends, because I lost my job, nice things when I worked [put in 32 years from 1980 age 16], car, everything.
I have long haul covid and developed Raynauds Syndrome and Narcolepsy since; diagnosed with an autoimmune disease since covid [Feb 14, 2021].
I need my teeth, my smile, back. People are cruel all the time and I have to wear a mask on zoom. That’s how bad my teeth are. I have documented severe dental PTSD also.
Katherine J.
Hi Patricia
I can relate to some of your issues.
I’m on Methadone, which is another subject entirely, but it causes tooth loose starting at the back of the mouth.
I was somewhat lucky that I have a denture on the top teeth from a car accident when I was about 10.
My bottom teeth are atrocious and
I have severe receding gum lines.
I know even with the top denture, I’m sure people can see the bottom even though my husband says that
He doesn’t. He only has 1 tooth in front and insurance from his work which is lacking in dental coverage.
I only have original Medicare, and if
I wanted, I could get a 50$ plan for one month of unlimited dental, then cancel after a month.
You should check the medicare advantage plan, which is the Sunflower plan.
I wish you the best of luck.
One last thing, I’m on about 6 meds for PTSD, severe depressive disorder, bipolar and extreme generalized anxiety.
My life is definitely not a bed of roses
A.C.
Hi, Patricia. We are sorry to hear about your condition and your situation. To apply for Medicaid or to request more information about Medicaid, you will need to call your state medical assistance office. To get the local phone number, call the Centers for Medicare & Medicaid Services at 1-800-633-4227 (TTY, 1-877-486-2048). We hope this helps.
Nellie M.
Why? Tell me why Medicare does not pay for medication that would help you lose weight since you have problems with double knee replacements and losing weight would help tell me why it will not cover the medication. I feel like I paid my dues.
Jim B.
It would be great if you could not talk about “Medicare Advantage” in the same space as real Medicare. Please explain that it is really private, for profit insurance that skims resources from Medicare as its business model and can deny treatments.
Linda R.
Thank you Jim. And so true. Just as charter schools skim off the necessary monies for the public schools.
Kudos.
James M.
Jim B. Right on! I think we are being duped by the Advantage plans. How much does it cost with all of the co-pays?
Russ M.
Is Original Medicare (Parts A & B) the best option for retired military with “Tricare for Life” serving as a Medigap plan?
Paige H.
Tricare and Medicare are both federal so “no” it won’t act as a Medigap plan. A medigap plan is a supplementary to Medicare. Call a local SHIP counselor to get complete information.
Diane H.
hhmm–I have Medicare and Tricare for Life. I’ve only needed to add dental and coverage for glasses. My prescriptions are covered after a very small deuctible, as are my dotor and hospital visits/stays. You should probably check with a militarycounselor about Tricare for Life.
larry, W.
If you are a veteran AND eligible for TriCare, you’ll be enrolled in Medicare Parts A&B, and Tricare, and rcv. medicare creditable, no-premium, prescription coverage too. Tricare works & feels like a medigap supplement for no cost. Use it, but do add an individual dental plan..
David
Having paid co-pay for some items at the day of the visit, I often get a later, aditional billing from the same service, sometimes 2/3 months later. Why is this & is it allowed?
Susan C.
Why you are receiving bills later for the same date of service is likely based on the specific Medicare Advantage plan you are enrolled in. The only way to find the most accurate answer is to call your plan directly and speak with the claims department. There are many reasons that could account for this, but I’m guessing you are not in Original Medicare but rather a Medicare Advantage plan, known as Medicare Part C and they each have different parameters, networks and co-pay structures. Hope this is helpful.
ABUBAKAR A.
yes am very interested
Ernest J.
You mention medicare but not eligability and signing up for medicaid?
A.C.
Hi, Ernest. Thanks for visiting our blog. To apply for Medicaid or to request more information about Medicaid, you will need to call your state medical assistance office. To get the local phone number, call the Centers for Medicare & Medicaid Services at 1-800-633-4227 (TTY, 1-877-486-2048). Thanks!
A.C.
Hi, David. Unfortunately, your situation is a bit more complex than we can handle in this forum. You may wish to contact your local Medicare SHIP (State Health Insurance Program Coordinator) to address your question. We hope this helps.
Cathy C.
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