What Percentage Does Medicare Cover

Introduction to Medicare

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 helps cover many health care costs, but understanding what percentage Medicare covers can be challenging. This guide aims to explain the various parts of Medicare, their coverage, and the associated costs.

What is Original Medicare?

Original Medicare consists of Part A and Part B. Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

Medicare Part A: Hospital Insurance

Medicare Part A helps cover:

• Inpatient hospital stays
• Skilled nursing facility care
• Hospice care
• Home health care

For most people, Part A is premium-free if you or your spouse worked and paid Medicare taxes for at least 10 years.

Medicare Part B: Medical Insurance

Medicare Part B helps cover:

• Doctor’s services
• Outpatient care
• Medical supplies
• Preventive services

Part B requires a monthly premium. The amount varies based on your income.

What Does Medicare Cover?

Medicare coverage varies depending on the service:

• Hospital Stays: Medicare covers a portion of the cost for inpatient hospital stays, with a deductible and coinsurance.
• Skilled Nursing Facility Care: Medicare covers a portion of the cost for a limited time, with coinsurance after the first 20 days.
• Hospice Care: Medicare covers most costs for hospice care, with some copayments.
• Doctor’s Services and Outpatient Care: Medicare covers 80% of the approved amount, and you pay the remaining 20% as coinsurance.

Medicare Supplement (Medigap) Insurance

Medicare Supplement Insurance, also known as Medigap, helps cover some of the out-of-pocket costs that Original Medicare does not cover, such as copayments, coinsurance, and deductibles. Medigap policies are sold by private companies.

Medicare Advantage Plans (Part C)

Medicare Advantage Plans, also known as Part C, are an alternative to Original Medicare. These plans are offered by private companies approved by Medicare and often include additional benefits like prescription drug coverage, vision, and dental care. You still pay the Part B premium and may have an additional premium for the Medicare Advantage Plan.

Medicare Part D: Prescription Drug Coverage

Medicare Part D provides prescription drug coverage and is offered by private insurance companies. You can get this coverage through a standalone prescription drug plan or a Medicare Advantage Plan that includes drug coverage. There is a monthly premium for Part D, which varies by plan and income level.

Out-of-Pocket Costs and Coverage

Understanding out-of-pocket costs is crucial to managing your healthcare expenses with Medicare. These costs include premiums, deductibles, copayments, and coinsurance. Here is a summary of the typical costs:

• Part A Deductible: You pay a deductible for each benefit period.
• Part B Premium: Most people pay a standard monthly premium, but higher-income individuals may pay more.
• Coinsurance and Copayments: You pay a share of the cost for services covered by Medicare.

Lifetime Reserve Days

Medicare provides 60 lifetime reserve days that can be used if you are in the hospital for more than 90 days. These days come with a higher coinsurance cost, and once they are used, they are not replenished.

We’re Here to Help

Understanding all the details of Medicare can be overwhelming, but you don’t have to navigate it alone. Green Insurance Agency in Orange Park, Florida, is here to help you understand your Medicare options and find the best plan for your needs. Don’t hesitate to call us at 904-717-1176 for personalized assistance.