Medicare

If you're in a Medicare Advantage Plan or other Medicare plan, your plan must give you at least the same coverage as Original Medicare. Some services may only be covered in certain settings or for patients with certain conditions.

In general, Part A covers:

2 ways to find out if Medicare covers what you need

  1. Talk to your doctor or other health care provider about why you need certain services or supplies. Ask if Medicare will cover them. You may need something that's usually covered but your provider thinks that Medicare won't cover it in your situation. If so, you'll have to read and sign a notice. The notice says that you may have to pay for the item, service, or supply.
  2. Find out if Medicare covers your item, service, or supply.

Medicare coverage is based on 3 main factors

  1. Federal and state laws.
  2. National coverage decisions made by Medicare about whether something is covered.
  3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.
Posted On Wed August 01st 2018

If you're in a Medicare Advantage Plan or other Medicare plan, you may have different rules. But, your plan must give you at least the same coverage as Original Medicare.

Some services may only be covered in certain settings or for patients with certain conditions.

Part B covers 2 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.

You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.  

Part B covers things like:

Posted On Sun February 25th 2018
  • Monthly premium:

 The Part C monthly premium varies by plan.

  • Deductibles, copayments, & coinsurance:

The amount you pay for Part C deductibles, copayments, and/or coinsurance varies by plan.

 Look for specific Part C plan costs, and then call the plans you're interested in to get more details.

Posted On Sun February 25th 2018
  • Monthly premium:

The Part D monthly premium varies by plan (higher-income consumers may pay more).

The chart below shows your estimated prescription drug plan monthly premium based on your income as reported on your IRS tax return.

If your income is above a certain limit, you'll pay an income-related monthly adjustment amount in addition to your plan premium. 

2018

If your filing status and yearly income in 2016 was
File individual tax return File joint tax return File married & separate tax return You pay each month (in 2018)
$85,000 or less $170,000 or less $85,000 or less your plan premium
above $85,000 up to $107,000 above $170,000 up to $214,000 not applicable $13.00 + your plan premium
above $107,000 up to $133,500 above $214,000 up to $267,000 not applicable $33.60 + your plan premium
above $133,500 up to $160,000 above $267,000 up to $320,000 not applicable $54.20 + your plan premium
above $160,000 above $320,000 above $85,000 $74.80 + your plan premium
Posted On Sun February 25th 2018