Does Medicare Always Pay 80 Percent?

Understanding Medicare and Its Parts

Medicare is a federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. It's crucial to understand how Medicare works to know what is covered and what is not. Let's take a closer look at the different parts of Medicare.

Medicare Part A and Part B

Original Medicare consists of Part A and Part B:

• Part A: Hospital Insurance, which covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

• Part B: Medical Insurance, which covers certain doctors' services, outpatient care, medical supplies, and preventive services.

Medicare Part B Coverage

Medicare Part B covers two main types of services:

• Medically Necessary Services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.

• Preventive Services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

It's important to note that Medicare Part B is optional, and you need to sign up for Part B when you become eligible for Medicare.

Medicare-Approved Amount

Medicare will pay 80 percent of the Medicare-approved amount for covered services. The Medicare-approved amount is the fee that Medicare deems reasonable for a service or supply. You are responsible for the remaining 20 percent, known as coinsurance, as well as any Part B deductible.

What Medicare Does Not Cover

Medicare does not cover everything. Some of the services and supplies that Medicare does not cover include:

• Long-term care (also called custodial care)

• Most dental care

• Eye exams related to prescribing glasses

• Denture care

• Cosmetic surgery

• Acupuncture

• Hearing aids and exams for fitting them

Medigap: Medicare Supplement Insurance

Medigap, also known as Medicare Supplement Insurance, can help pay some of the health care costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles. Medigap policies are sold by private companies and can provide additional coverage to help with your out-of-pocket costs.

Medicare Advantage Plans

Medicare Advantage Plans (also known as Part C) are an all-in-one alternative to Original Medicare. These plans are offered by private companies approved by Medicare and include Part A, Part B, and usually Part D (prescription drug coverage). Medicare Advantage Plans may offer additional benefits that Original Medicare doesn't cover, such as vision, hearing, dental, and wellness programs.

Prescription Drug Coverage (Part D)

Medicare Part D provides prescription drug coverage. Part D plans are offered by insurance companies and other private companies approved by Medicare. Each plan can vary in cost and the specific drugs covered. Having a Part D plan can help reduce your out-of-pocket costs for prescription medications.

Eligibility and Enrollment

To be eligible for Medicare, you or your spouse need to have worked and paid Medicare taxes for at least 10 years. You can sign up for Medicare during your Initial Enrollment Period, which starts three months before you turn 65 and ends three months after the month you turn 65. If you miss this period, you may have to pay a late enrollment penalty.

Late Enrollment Penalties

If you do not enroll in Medicare Part B when you first become eligible, you may have to pay a late enrollment penalty for as long as you have Part B. This penalty is added to your monthly Part B premium and can be costly, so it's important to enroll on time.

We're Here to Help

Understanding Medicare and its various parts can be complicated, but you don't have to navigate it alone. Bourgeois Insurance Agency, LLC is here to help you understand your options and find the best coverage for your needs. Call us today at (985) 803-8999 to speak with one of our knowledgeable agents. We are located in Thibodaux, Louisiana, and are ready to assist you with all your Medicare questions and needs.

Don't wait—call Bourgeois Insurance Agency, LLC at (985) 803-8999 today and get the Medicare coverage you deserve!