Análisis de los Indicadores Financieros

Original Medicare is a federal health insurance program for people age 65 or older, under age 65 with certain disabilities, and any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney trans- plant).

Medicare has the following parts:

• Part A (Hospital Insurance)

• Part B (Medical Insurance)

• Part C (Medicare Advantage Plans, like an HMO)

• Part D (Medicare prescription drug coverage)

M

P

A

Medicare Part A helps cover inpatient care in hospitals. This includes critical access hospitals and inpatient rehabilitation facilities. It also helps cover hospice care and home health care, and skilled nursing facilities (but not custodial or long-term care). You must meet certain conditions to get these benefits. You usually don’t pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working.

M

P

B

Medicare Part B helps cover medically necessary services like doctors’ services, outpatient care, and other medical services. Part B also covers some preventive services. These include a one-time “Welcome to Medicare” physical exam, bone mass measurements, flu and pneumococcal shots, cardiovascular screen- ings, cancer screenings, diabetes screenings, an annual wellness exam, and more.

M

P

C

Costs can vary widely depending on your state and the private insurer you choose, as well as whether you choose an HMO or PPO for coverage.

If you are enrolled in a Medical Trust Medicare Supplement Plan, you may not enroll in a Medicare Advantage Plan.

M

P

D

Medicare Part D is a program to subsidize the cost of certain prescription drugs for Medicare beneficiaries.

This coverage may help lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. You choose the drug plan and pay a monthly premium. Like other insurance, if you decide not to enroll in a drug plan when you are first eligible, you may pay a penalty if you choose to join later, but only if you do not have employer coverage that meets Medicare’s credita- ble coverage definition.

If you are enrolled in a Medical Trust Medicare Supplement Plan with prescrip- tion drug coverage, your benefits are considered creditable coverage, which means it is equal to (if not better than) the coverage available under other Medi- care Part D plans.

S

C

M

Different services and supplies are covered under Medicare Part A and Part B when medically necessary.

Medicare Part A helps pay for:

• Inpatient hospital care

• Skilled nursing facility care

• Hospice care

• Some home health care

• Pints of blood you receive at a hospital or skilled nursing facility during a covered stay

Medicare Part B helps pay for:

• Outpatient hospital care

• Some other medical services that Medicare Part A does not cover (such as some of the services of physical and occupational therapists, and some home health care)

• Pints of blood you receive as an outpatient or as part of a Medicare Part B covered service

Original Medicare also helps cover:

• Ambulance services

• Chiropractic services (limited)

• Clinical research studies

• Diabetic self-management training

• Diabetic supplies

• Durable medical equipment

• Emergency room services

• Eyeglasses (after cataract surgery)

• Foot exams and treatment

• Hearing and balance exams

• Kidney dialysis services

• Medical nutrition therapy services

• Mental healthcare

• Practitioner services

• Prosthetic and orthotic items (with certain limitations)

• Second surgical opinion

• Smoking cessation counseling

• Surgical dressings

• Tests

• Transplant services

• Travel outside the United States (only when in US but nearest treatment facility is outside the country, or when crossing international borders in order to get from US territory to another)

• Urgently needed care

S

N

C

O

M

Original Medicare does not cover everything. Items and services that aren’t cov- ered include, but are not limited to:

• Deductibles, coinsurance, copayments

• Dental care and dentures (with a few exceptions)

• Eye refractions

• Healthcare while outside the US (except in certain circumstances)

• Hearing aids and hearing aid fitting exams

• Hearing tests without doctor’s orders

• Long-term care (such as custodial care in a nursing home)

• Orthopedic shoes (with only a few exceptions)

• Routine foot care (with only a few exceptions)

• Routine eye care and most eyeglasses

• Screening tests and screening laboratory tests (except certain preventive screenings)

• Shots (vaccinations) except certain preventive procedures

• Some diabetic supplies (syringes or insulin, except when used in an insu- lin pump)

T

F

D

Many doctors accept Medicare assignment. If you need help finding a provider that accepts Medicare assignment to help keep your overall healthcare costs down, visit www.medicare.gov/physician/home.asp, or contact Medicare di- rectly at (800) MEDICARE (1 (800) 633-4227), 24 hours a day, 7 days a week for assistance. TTY users should call 1 (877) 486-2048

.

F

M

I

This handbook does not include everything that is covered or excluded by Med- icare. For more detailed information or to request a copy of the publication Med-

icare and You, please contact Medicare at (800) MEDICARE (1 (800) 633-4227),

24 hours a day, 7 days a week for assistance. TTY users should call 1 (877) 486- 2048

.