| Wed, Jul 13, 2011 @ 09:00 AM

Original Medicare – Who Qualifies and How to Fill in the Gaps

Posted by Medicare Made Clear

Original Medicare (Parts A and B) helps pay for some of your hospital and medical services. To get help covering gaps in coverage, like prescription drug insurance, vision or dental coverage, you can enroll in a Medicare plan offered through an insurance company.  These plans offer additional benefits, often for a low or perhaps no additional monthly premium. Additionally, you pay a copay or coinsurance only for the benefits and services you use.Original Medicare, also known as Medicare Part A and Part B, covers a wide range of hospital and medical services, but not all services are covered. Learning more about what Original Medicare does and doesn’t cover can help you decide whether or not you want to add coverage to help fill in the gaps and provide you with more complete health coverage.

Original Medicare – What’s Covered?

Medicare Part A, provides coverage for short-term inpatient care in hospitals and skilled nursing facilities, and hospice care.
Medicare Part B, covers medically necessary outpatient services. These are services or supplies deemed necessary to diagnose or treat a medical condition. Preventive services (care that prevents illness (like the flu) or detects it at an early stage when treatment is likely to work best) are also covered under Medicare Part B.

Original Medicare – What’s Not Covered?

  • Most dentalcare
  • Routine eye care
  • Routine hearing tests
  • Most care while traveling outside the United States
  • Custodial care (help with bathing, dressing, eating, etc.)
  • Long-term care
  • Cosmetic surgery
  • Most chiropractic services
  • Routine foot care
  • Acupuncture
  • Prescription drug coverage is available but not automatically included

You Can Add the Coverage You Need

There are a number of plans available that you can add to Original Medicare to provide the coverage you need. These Medicare plans are available through private insurance companies, and may differ by plan, cost, coverage and service area. The types of Medicare plans that may be available to you, depending on where you live, fall into three groups:

  • Medicare Advantage (Part C), covers all the same services as Original Medicare and may include additional benefits and services like routine vision, hearing and preventive care, gym memberships, and may include prescription drug coverage often at no additional premium. Some plans offer limited dental coverage or more comprehensive dental coverage for an additional monthly premium.
  • Medicare Part D, also known as a prescription drug plan, covers prescription medications.  Original Medicare members may purchase Part D as a stand-alone plan. Medicare Advantage members may get prescription drug coverage included as part of a Medicare Advantage plan.
  • Medicare Supplement Plans, also known as Medigap, can help pay Original Medicare deductibles, coinsurance and permissible excess charges, blood transfusion coverage, additional hospital day coverage and more. Some Medicare Supplement Plans help pay more of these benefits than others, and not all plans are available in all states.

To look into plans available in your area, try the Medicare Plan Finder at www.medicare.gov, or contact your State Health Insurance Program (SHIP). By researching your choices for Medicare Advantage, Medicare Part D and Medicare Supplement Insurance plans, you can make arrangements for coverage you need beyond Original Medicare.

For more information contact the Medicare helpline 24 hours a day, 7 days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. You can also contact Medicare Made Clear to learn more 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, 7 days a week.
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