Kamo Insurance Agency - Medicare
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Medicare
 
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Medicare
     Medicare is the Federal health insurance program for Americans age 65 and older and for certain disabled Americans. If you are eligible for Social Security or Railroad Retirement benefits and are age 65, you and your spouse automatically qualify for Medicare.
     Medicare has three parts: hospital insurance, known as Part A, supplementary medical insurance, known as Part B, which provides payments for doctors and related services and supplies ordered by the doctor, and prescription drug coverage, known as Part D which covers both brand-name and generic prescription drugs at participating pharmacies in your area. If you are eligible for Medicare, Part A is free, but you must pay a premium for Part B and Part D.
     Medicare will pay for many of your health care expenses, but not all of them. In particular, Medicare does not cover most nursing home care, long-term care services in the home, or prescription drugs. There are also special rules on when Medicare pays your bills that apply if you have employer group health insurance coverage through your own job or the employment of a spouse.
     Medicare usually operates on a fee-for-service basis. HMOs and similar forms of prepaid health care plans are now available to Medicare enrollees in some locations.
     The best source of information on the Medicare program is the Medicare Handbook. This booklet explains how the Medicare program works and what your benefits are. To order a free copy, go to: www.medicare.gov. You also can contact your local Social Security office for information.
     Some people who are covered by Medicare buy private insurance, called "Medigap" policies, to pay the medical bills that Medicare doesn't cover. Some Medigap policies cover Medicare's deductibles; most pay the coinsurance amount. Some also pay for health services not covered by Medicare. There are 10 standard plans from which you can choose. (Some States may have fewer than 10.) If you buy a Medigap policy, make sure you do not purchase more than one.
     You need to shop carefully before deciding on the best policy to fit your needs. You may get another booklet, Guide to Health Insurance for People with Medicare, to help you in making the right choice. To order a free copy, go to: www.medicare.gov.
     Another good source of information on the same topic is The Consumer's Guide to Medicare Supplement Insurance. To order a free copy, go to: www.medicare.gov.
Medicaid
Medicaid provides health care coverage for some low-income people who cannot afford it. This includes people who are eligible because they are aged, blind, or disabled or certain people in families with dependent children. Medicaid is a Federal program that is operated by the States, and each State decides who is eligible and the scope of health services offered.
     General information on the Medicaid program is given in the Medicaid Fact Sheet. For a free copy, go to: www.medicare.gov. For specifics on Medicaid eligibility and the health services offered, contact your State Medicaid Program Office.
 
The Medicare Program 
 
Medicare is a health insurance program for:
  • People age 65 or older.
  • People under age 65 with certain disabilities.
  • People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
 
The Original Medicare Has Two Parts 
Part A - Hospital Insurance.
Most people pay for Part A through their payroll taxes when they are working.
Part B - Medical Insurance.
Most people pay monthly for Part B.
 
You can elect to participate in a Medicare Advantage Plan Part C and Medicare Prescription Drug Coverage Part D 
Medicare Advantage Plans
 
You can choose different ways to get the services covered by Medicare. Depending on where you live, you may have different choices. In most cases, when you first get Medicare, you are in the Original Medicare Plan. Or, you may want to consider a Medicare Advantage Plan (like an HMO or PPO) that provides all your Part A, Part B, and often Part D (Medicare Prescription Drug) coverage. You make a choice when you are first eligible for Medicare. Each year you can review your health and prescription needs and switch to a different plan in the fall.
 
Medicare Advantage Plans are health plan options that are approved by Medicare but run by private companies. They are part of the Medicare Program, and sometimes called "Part C." When you join a Medicare Advantage Plan, you are still in Medicare. As long as you have both Part A and Part B, items covered by Part A and Part B are covered whether you have the Original Medicare Plan, or you belong to a Medicare Advantage Plan (like an HMO or PPO).
 
Part D - Prescription Drug Coverage
Medicare Prescription Drug Plans are offered by insurance companies and other private companies approved by Medicare.
 
 
Medicare Health Plans 
Today's Medicare is about choice. Your health plan choices include:
  • The Original Medicare Plan
  • Medicare + Choice Plans, including:
    • Medicare Managed Care Plans
    • Medicare Private Fee-for-Service Plans
    • Medicare Preferred Provider Organization Plans
     
  •  
Medicare + Choice Plans are available in many areas.
The Medicare health plan that you choose affects many things like cost, benefits (some have extra benefits like prescription drugs), doctor choice, convenience, and quality.
 
What is Medicare Part A? 
     Medicare Part A (Hospital Insurance) helps cover your inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. You must meet certain conditions.
 
  • Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.
  • The Part A premium is $423.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.
  • Medicare Part A Helps Cover Your Medically Necessary:
 
Hospital Stays
Semiprivate room, meals, general nursing, and other hospital services and supplies. This includes inpatient care you get in critical access hospitals and mental health care. This doesn't include private duty nursing, or a television or telephone in your room. It also doesn't include a private room, unless medically necessary. Inpatient mental health care in a psychiatric facility is limited to 190 days in a lifetime.
Skilled Nursing Facility Care
Semiprivate room, meals, skilled nursing and rehabilitative services, and other services and supplies (after a related 3-day inpatient hospital stay).
Home Health Care
Part-time or intermittent skilled nursing care and home health aide services, physical therapy, occupational therapy, speech-language therapy, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers), medical supplies, and other services.
Hospice Care
For people with a terminal illness, includes drugs for symptom control and pain relief, medical and support services from a Medicare-approved hospice, and other services not otherwise covered by Medicare. Hospice care is usually given in your home. However, Medicare covers some short-term hospital and inpatient respite care (care given to a hospice patient so that the usual caregiver can rest).
Blood
Pints of blood you get at a hospital or skilled nursing facility during a covered stay.
 
What is Medicare Part B?
 
     Medicare Part B (Medical Insurance) helps cover your doctors' services and outpatient hospital care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.
 
     You pay the Medicare Part B premium each month*. In some cases, this amount may be higher if you didn't sign up for Part B when you first became eligible. The cost of Part B may go up 10% for each 12-month period that you could have had Part B but didn't sign up for it, except in special cases. You will have to pay this extra amount as long as you have Part B.
 
Medicare Part B Helps Cover Your Medically Necessary:
 
Medical and Other Services
Doctors' services (not routine physical exams), outpatient medical and surgical services and supplies, diagnostic tests, ambulatory surgery center facility fees for approved procedures, and durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers). Also covers second surgical opinions, outpatient mental health care, and outpatient occupational and physical therapy including speech-language therapy. (These services are also covered for long-term nursing home residents.).
Clinical Laboratory Services
Blood tests, urinalysis, some screening tests, and more.
Home Health Care
Part-time or intermittent skilled nursing care and home health aide services, physical therapy, occupational therapy, speech-language therapy, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers), medical supplies, and other services.
Outpatient Hospital Services
Hospital services and supplies received as an outpatient as part of a doctor's care.
Blood
Pints of blood you get as an outpatient or as part of a Part B covered service.
 
What is the Original Medicare Plan? 
     The Original Medicare Plan is a "fee-for-service" plan. This means you are usually charged a fee for each health care service or supply you get. This plan, managed by the Federal Government, is available nationwide. If you are in the Original Medicare Plan, you use your red, white, and blue Medicare card when you get health care. If you are happy getting your health care this way, you don't have to change. You will stay in the Original Medicare Plan unless you choose to join a Medicare + Choice Plan.
 
Your costs in the Original Medicare Plan 
What you pay out-of-pocket depends on:
  • Whether you have Part A and Part B
  • Whether your doctor or supplier agrees to accept "assignment"
  • How often you need health care
  • What type of health care you need
  • Whether you choose to get services or supplies not covered by Medicare. In this case, you would pay for these services yourself.
  • Whether you have other insurance
 
Nathan W. Kamo
Phone 702-326-9056
Fax 702-974-0930
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