Medicare Part A and B: A Basic Guide
Between our aging population and the Affordable Care Act requiring healthcare insurance for all citizens, health insurance is a major concern. However, thanks to Medicare, health insurance is available to more of the population. Medicare is a form of Federal Health Insurance aimed at citizens over 65 years of age, certain younger people with disabilities, and patients with ESRD (End-Stage Renal Disease). This government assistance program covers medical costs. There are many forms of Medicare and coverage depends on the Local and National policies, as well as the medical necessity of the care required. Of the different types of Medicare available, Medicare part A and B are the most common types used for basic coverage. Medicare Part A (Hospital Insurance) encompasses the overall care of what is deemed medically necessary for more long-term care, such as:
Hospital care Skilled Nursing Facility Care Nursing Home Care (beyond just custodial care) Hospice Home Health Services
Medicare Part A cost generally does not require a premium payment each month and is covered if an individual or their spouse (aged 65 or older) paid Medicare taxes while working. It also covers those receiving benefits from Social Security or the Railroad Retirement Board. Medicare Part A costs can range up to $411 a month. Medicare Part B (Medical Insurance) covers medically necessary services, as well as preventive services, including, but not limited to:
Clinical research Ambulance services Durable medical equipment (DME) Mental Health: o Inpatient o Outpatient o Partial hospitalization
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Getting a second opinion before surgery Limited outpatient prescription drugs
Medicare Part B cost, unlike Medicare Part A, does require a standard premium payment, along with an Income Related Monthly Adjustment Amount (IRMAA) for certain individuals based on income. To determine if your Medicare covers the costs for medical procedures or supplies, it is best to talk to your doctor or health care provider. If your provider does not think Medicare will cover your costs, you will sign a notice saying you may have to pay for the noncoverage. Since National and State laws, as well as local insurance distributors using Medicare, determine if a procedure is medically necessary, it is helpful to also find out if Medicare covers your required item, service, or supply. If you are not automatically enrolled in Medicare Part A and B, the enrollment period occurs from January 1 to March 31 of each year, as well as 3 months before a citizen turning 65 and 3 months after. A Special Enrollment Period is available to those under a group health plan and working. The Gonzaba Medical Group provides excellent health care for older patients. If you have questions about whether a procedure is covered by Medicare, you can call (210) 921-3800 or visit them online at http://www.gonzaba.com/.