Welcome to our comprehensive guide on Medicare coverage, designed to help you understand Medicare and navigate the complexities of Medicare. At Plan Medicare, we understand that choosing the right healthcare plan is an important decision, and we are here to provide you with all the information you need to make an informed choice. In this guide, we will provide you with a detailed overview of Original Medicare, including what is covered, what isn’t covered, and how to enroll.

Medicare Coverage Overview: Original Medicare

Original Medicare is the basic health insurance plan offered by the federal government to individuals aged 65 or older, or those with certain disabilities. It consists of two main parts: Part A and Part B.

Part A covers inpatient hospital stays, hospice care, and skilled nursing facilities. If you or a loved one needs to be admitted to the hospital, Part A will cover your stay, as well as any necessary medications and procedures. Hospice care is also covered under Part A, and provides end-of-life care to individuals who have a terminal illness. Finally, if you need to stay in a skilled nursing facility for rehabilitation or long-term care, Part A will cover the cost.

Part B covers outpatient medical expenses, such as doctor visits, lab tests, and preventive care. If you need to see a doctor, get a blood test, or have a preventive screening, Part B will cover these costs. It also covers certain medical equipment, such as wheelchairs and walkers.

What’s Not Covered by Original Medicare

While Original Medicare covers a wide range of medical expenses, there are certain services and items that are not covered. Some of the most notable exclusions include:

• Prescription drugs: Medicare Part A and Part B do not cover most prescription drugs. To get coverage for your medications, you will need to enroll in a Part D prescription drug plan, or a Medicare Advantage plan.
• Dental and vision care: Routine dental and vision care, such as cleanings and exams, are not covered by Original Medicare. However, certain medically necessary procedures, such as cataract surgery, may be covered.
• Long-term care: Original Medicare does not cover long-term care in a nursing home or other assisted living facility. If you need long-term care, you will need to explore other options, such as Medicaid or a long-term care insurance policy.

Part C, also known as Medicare Advantage, is an alternative to Original Medicare. These plans are offered by private insurance companies and provide all the same benefits as Original Medicare, plus additional benefits such as dental, vision, and prescription drug coverage. Some Medicare Advantage plans also offer other benefits, such as gym memberships or transportation to medical appointments.

Part D is Medicare’s prescription drug coverage program. It is available to all beneficiaries who are enrolled in either Original Medicare or a Medicare Advantage plan that does not include prescription drug coverage. Part D plans are also offered by private insurance companies and provide coverage for most prescription drugs.

Enrolling in Original Medicare

If you are turning 65 and are not already receiving Social Security benefits, you will need to enroll in Original Medicare during your Initial Enrollment Period (IEP). Your IEP begins three months before the month you turn 65 and ends three months after the month you turn 65. If you miss your IEP, you may be subject to late enrollment penalties.

To enroll in Original Medicare, you can visit the Social Security Administration website, call their toll-free number, or visit your local Social Security office. Once you are enrolled in Original Medicare, you can explore additional coverage options, such as Medicare Advantage and Part D prescription drug plans.

We hope this guide has provided you with a comprehensive overview of Original Medicare and has helped you understand what is covered, what isn’t covered, and how to enroll. At Plan Medicare, we are committed to helping you educate and enroll in the best Medicare option that fits your needs and budget. Call 516-900-7877 to speak with a licensed New York Medicare Insurance Agent at Plan Medicare and we will talk you through all of your Medicare questions.