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LEFT NAVIGATION

 * Is my test, item, or service covered?
 * Your Medicare coverage choices
   * What's Medicare?
   * How Original Medicare works
   * Consider these 7 things when choosing coverage
 * What Part A covers
 * What Part B covers
 * What Medicare health plans cover
 * Preventive & screening services
 * What's not covered by Part A & Part B


CONSIDER THESE 7 THINGS WHEN CHOOSING COVERAGE


Costs

How much are your premiums, deductibles, and other costs? How much do you pay
for services like hospital stays or doctor visits? Is there a yearly limit on
what you could pay out-of-pocket for medical services? Make sure you understand
any coverage rules that may affect your costs.


COSTS IN ORIGINAL MEDICARE

There’s no limit on how much you pay out-of-pocket per year unless you
have supplemental coverage.


COSTS IN MEDICARE ADVANTAGE

Plans have a yearly limit on your out-of-pocket costs. If you join a Medicare
Advantage Plan, once you reach a certain limit, you’ll pay nothing for covered
services for the rest of the year. This option may be more cost effective for
you.


NOTE:

If you're in a Medicare plan, review the "Evidence of Coverage" (EOC)
and  "Annual Notice of Change" (ANOC) .

Coverage

How well does the plan cover the services you need?


COVERAGE IN ORIGINAL MEDICARE

Medicare covers medical services and supplies in hospitals, doctors’ offices,
and other health care facilities. Services are either covered under Part
A or Part B.


COVERAGE IN MEDICARE ADVANTAGE

Plans must cover all of the services that Original Medicare covers. Some plans
offer benefits that Original Medicare doesn’t cover like vision, hearing, or
dental.


NOTE:

If you're in a Medicare plan, review the "Evidence of Coverage" (EOC)
and  "Annual Notice of Change" (ANOC) .

Your other coverage

If you have other types of health or prescription drug coverage, make sure you
understand how that coverage works with Medicare. If you have employment-related
coverage, or get your health care from an Indian Health or Tribal Health
Program, talk to your
benefits

The health care items or services covered under a health insurance plan. Covered
benefits and excluded services are defined in the health insurance plan's
coverage documents.

administrator or insurer before making any changes. 


SUPPLEMENTAL COVERAGE IN ORIGINAL MEDICARE

You can add a Medigap policy to help pay your out-of-pocket costs in Original
Medicare, like your
deductible

The amount you must pay for health care or prescriptions before Original
Medicare, your Medicare Advantage Plan, your Medicare drug plan, or your other
insurance begins to pay.

and
coinsurance

An amount you may be required to pay as your share of the cost for services
after you pay any deductibles. Coinsurance is usually a percentage (for example,
20%).

.


SUPPLEMENTAL COVERAGE IN MEDICARE ADVANTAGE

It may be more cost effective for you to join a Medicare Advantage Plan because
your cost sharing is lower (or included). And, many Medicare Advantage plans
offer vision, hearing, and dental. You can’t use (and can’t be sold) a Medigap
policy if you’re in a Medicare Advantage Plan.


NOTE:

If you're in a Medicare plan, review the "Evidence of Coverage" (EOC)
and  "Annual Notice of Change" (ANOC) .

Prescription drugs

Do you need to join a Medicare Prescription Drug Plan? Do you already have 
creditable prescription drug coverage

Prescription drug coverage (for example, from an employer or union) that's
expected to pay, on average, at least as much as Medicare's standard
prescription drug coverage. People who have this kind of coverage when they
become eligible for Medicare can generally keep that coverage without paying a
penalty, if they decide to enroll in Medicare prescription drug coverage later.

? Will you pay a 
penalty

An amount added to your monthly premium for Part B or a Medicare drug plan (Part
D) if you don't join when you're first eligible. You pay this higher amount as
long as you have Medicare. There are some exceptions.

 if you join a drug plan later? What's the plan’s overall star rating? What will
your prescription drugs cost under each plan? Are your drugs covered under the
plan's 
formulary

A list of prescription drugs covered by a prescription drug plan or another
insurance plan offering prescription drug benefits. Also called a drug list.

? Are there any coverage rules that apply to your prescriptions? Are you
eligible for a free 
Medication Therapy Management (Mtm)

Plans with Medicare drug coverage must offer additional free Medication Therapy
Management services to plan members who meet certain requirements. Members who
qualify can get these services to help them understand how to manage and use
their drugs safely. Medication Therapy Management services usually include a
discussion with a pharmacist or health care provider to review
your medications. These services may vary in some plans.

 program?

Prescription drug coverage in Original Medicare

You’ll need to join a 
Medicare Drug Plan (Part D)

Part D adds prescription drug coverage to:

 * Original Medicare
 * Some Medicare Cost Plans
 * Some Medicare Private-Fee-for-Service Plans
 * Medicare Medical Savings Account Plans

These plans are offered by insurance companies and other private companies
approved by Medicare. Medicare Advantage Plans may also offer prescription drug
coverage that follows the same rules as Medicare  drug plans.

 to get drug coverage.

Prescription drug coverage in Medicare Advantage

Most Medicare Advantage Plans include drug coverage. If yours doesn't, you may
be able to join a separate Part D plan.


NOTE:

If you're in a Medicare plan, review the "Evidence of Coverage" (EOC)
and  "Annual Notice of Change" (ANOC) .

 

Doctor and hospital choice

Do your doctors accept the coverage? Are the doctors you want to see accepting
new patients? Do you have to choose your hospital and health care providers from
a network? Do you need to get referrals?

Doctor and hospital choice in Original Medicare

You can go to any doctor that accepts Medicare.

Doctor and hospital choice in Medicare Advantage

You may need to use health care providers who participate in the plan’s 
network

The facilities, providers, and suppliers your health insurer or plan has
contracted with to provide health care services.

. If so, find out how close the network’s doctor or pharmacies are to your home.
Some plans offer out-of-network coverage. 


NOTE:

If you're in a Medicare plan, review the "Evidence of Coverage" (EOC)
and  "Annual Notice of Change" (ANOC) .

 

Quality of care

Are you satisfied with your medical care? The quality of care and services
offered by plans and other health care providers can vary. How have Medicare and
other people with Medicare rated your health and drug plan’s care and
services? Get help comparing plans and providers.

Travel


TRAVEL COVERAGE IN ORIGINAL MEDICARE

Original Medicare generally doesn’t cover care outside the U.S. You may be able
to buy supplemental insurance that offers emergency care when you travel outside
of the U.S. 


TRAVEL COVERAGE IN MEDICARE ADVANTAGE

Plans usually don’t cover care you get outside of the U.S.


EXAMPLE:

If you're in a Medicare plan, review the "Evidence of Coverage" (EOC)
and  "Annual Notice of Change" (ANOC) .

 


FIND OUT WHO TO CALL ABOUT MEDICARE OPTIONS, CLAIMS AND MORE.

Talk to Someone


IS MY TEST, ITEM, OR SERVICE COVERED?

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