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Is Medicare only available to me when I turn 65?

President Johnson created the Medicare program in 1965. Oddly enough, this was one year after the “baby boom generation” period ended. More than 12,500 people in the US turn 50 every day, and as the population has grown older, the Medicare program has also expanded.
There is a misconception that Medicare only pays healthcare needs for seniors. In fact, many groups of people who are not over 65 are eligible for Medicare assistance. In general, these groups can be filed into these three categories:

  • People who are 65 and older
  • People under 65 who have disabilities and illnesses that qualify them for Medicare
  • People of any age who suffer kidney failure and require dialysis or who need a kidney transplant

If you are eligible and under the age of 65, then you can start receiving Medicare assistance to pay for your medical bills. Medicare breaks down into different parts known as Part A, Part B, Part C and Part D. You may qualify for all Medicare plans even if you are under the age of 65.

How to Get Medicare Under 65

Whether you are 18 or 32, if you have Lou Gehrig’s disease, kidney failure or certain disabilities, then you are eligible to receive Medicare benefits. There may be a waiting period, however, before you are able to receive any benefits. These are some details on how to get Medicare if you fall into one of the under 65 categories above.
Lou Gehrig’s Disease
Amyotrophic lateral sclerosis (ALS) is mostly known by its common name, Lou Gehrig’s Disease. This is a disease that affects the nerves in the human brain and spinal cord. The neurons progressively degenerate until they die. Patients often become completely paralyzed with the loss of motor neurons.
For these individuals, people with ALS can apply for social security disability benefits, and as soon as you start receiving those benefits, you are automatically enrolled in Medicare. There aren’t any waiting periods if you have this disease. In this case, your process starts by applying for social security disability, which you can do online. You are covered under Medicare Part A and Part B, which covers all of your doctor’s visits, hospitalization, skilled nursing facilities and other medical needs.
Kidney Failure
End-Stage Kidney Disease occurs in the last stages of chronic kidney disease. This is when kidneys can’t support the body’s needs any longer meaning that it can’t remove waste or excess water. The most common reason for this disease is if you have high blood pressure and diabetes, but there are other causes for kidney disease.
If you have End-Stage Kidney Disease, you are only eligible for Medicare Part A and Part B. You cannot receive Medicare Part C or Medicare Advantage with this illness. In addition, you must need dialysis or kidney transplant in order to qualify. You can’t receive Medicare until three months after starting dialysis. Once a doctor diagnoses you with kidney failure, you’ll start the process through the Social Security Administration and will automatically be enrolled in Medicare.
Other Disabilities Qualified for Medicare
If you are on Social Security Disability, then you also can receive Medicare, and you may even be eligible for all Medicare plans including Medicare Advantage, prescription drug coverage and Medigap. However, if it isn’t one of the diseases above, you typically have to wait two years after first receiving social security disability benefits to start Medicare. After 24 months, Social Security Administration signs you up automatically for Medicare.

What Medicare Covers if You Are Under 65

Even if you are under the age of 65, your benefits remain the same as coverage doesn’t depend on age. The following covers the different parts of Medicare and what is covered under each.
Medicare Part A
Medicare covers services like doctor visits, surgeries and lab tests. Supplies like wheelchairs and walkers are also covered since they are viewed as necessary for conditions and diseases that limit functionality.
The following is covered by Medicare Part A:

  • Hospital care
  • Skilled nursing facility care
  • Nursing home care
  • Hospice care
  • Health care at home

Medicare Part B
What isn’t covered under Medicare Part A, excluding prescription drugs, is covered under Medicare B. There are different parts of Medicare B that take care of your services and supplies for medical needs.
Medically necessary services: these are supplies or services that are necessary to diagnose and treat any medical conditions and also meet accepted standards of medical practice.
Preventive Services
Health care that prevents illness like the flu or that can be detected at an early stage when treatment is most likely to work better.
You don’t have to pay anything for preventive services if you receive care from health care provider and who accepts Medicare plans.
Part B coverage includes:

  • Clinical research
  • Ambulance services
  • Mental health
    • Inpatient
    • Outpatient
    • Partial hospitalization
  • Seeing a specialist for a second opinion before surgery
  • Some outpatient prescription drug coverage

Medicare Part C
Medicare Part C is known as Medicare Advantage. With these plans, all services covered above in Part A and Part B are also covered in Medicare Part C. However, your policy goes through a private insurance company rather than the government. You are still a part of the Medicare program and receive protection and rights, but you only have one insurance card and make one payment to an insurance company. You can also receive extra services. For example, some private health insurance companies offer extras like:

  • Vision
  • Dental
  • Hearing aids
  • Free annual physical exams
  • Gym memberships
  • Wellness programs
  • Generic and brand-name prescription drugs

All plans offer different services under Medicare Part C, so you’ll need to compare and look for the best plan for your health and budget needs. Major health insurance companies offer plans for as little as $40 a month, but you still have to pay your Part B premium in most cases. Discounts are available depending on your income. Under Medicare Part C, End Stage Kidney Disease is not covered.
If you have questions involving Medicare and what you qualify for, you can always reach out to MedicarePartC.com for specific answers. We also answer various questions related to Medicare and Medicare Advantage right on our site. With videos and different guides, we aim to make it easier for individuals over and under 65 to receive their Medicare benefits.

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Will Medicare Cover Care for My Whole Family?

Since 1965, Medicare has provided medical insurance to individuals. Unfortunately, Medicare is not the program that covers health insurance for families. This program is designed to cover one individual at a time, which means that a man, woman or child must apply and be approved individually by Medicare to receive coverage. If you are wondering who is eligible for Medicare in your family, there are a number of factors that actually determine who is eligible. In general, you become eligible for Medicare if you are aged 65 years or older or if you are younger than 65 and meet specific criteria for disabilities. This guide goes through different parts of Medicare and who is eligible to receive coverage.

Who is Eligible for Medicare Part A (hospital insurance)

Medicare Part A covers most hospital stay costs and some follow-up medicare care. To be eligible for Medicare Part A, you must meet the following requirements.

  • You must be age 65 or older
  • Most people receive Medicare Part A coverage for free
  • You may pay for Medicare if you do not have a long enough work history
  • You qualify if you are under 65 if you have a disability or other condition
  • You have end-stage renal disease
  • You are automatically enrolled in Part A if you receive benefits from Social Security after 24 months of being on disability

Once you become eligible for Medicare Part A, you are automatically eligible for Part B as well.

Who is Eligible for Medicare Part B (medical insurance)

Eligibility for Part B is much like eligibility for Part A. However, typically if you are eligible for Part A, then you will automatically be eligible for Part B.

  • You are 65 years or older
  • You are under 65 but have a disability or condition that you receive Social Security income for
  • You have End-Stage Renal Disease
  • Part B is optional when you first enroll, so make sure to sign up to avoid a late penalty for signing up later

Who is Eligible for Part C

Medicare Part C or Medicare Advantage follows the same eligibility rules for Part A and Part B, which means that you can receive Medicare Advantage if you are already approved or enrolled in Medicare.

  • You already receive Part A
  • You are enrolled in Part B
  • You live in a service area that is eligible for Part C
  • You don’t have End Stage Disease
  • You don’t require hospice care

Medicare Advantage plans are offered by private health insurance companies, but they still must be approved by the government. If you already receive Medicare, then you can switch to Medicare Advantage during an open or special enrollment period.

Who is Eligible for Part D

Medicare offers prescription drug coverage to anyone who is eligible for Medicare. However, you need to sign up for prescription drug coverage when you become eligible, or else you will pay a late enrollment fee.
To get Medicare drug coverage, you have to join a plan that is approved by Medicare but offered through a private insurance company like Humana or Aetna. There are typically two methods of getting Medicare prescription drug coverage.

  • Medicare Prescription Drug Plan

These plans are known as PDPs and add drug coverage to Original Medicare or Part A and Part B. These plans may be also included under Medicare Cost plans or Medicare Private Fee for Service plans.

  • Medicare Advantage Plan

If you decide to get a Medicare Advantage Plan or Part C, then your coverage will switch from Original Medicare to Medicare Advantage and include prescription drugs. These plans are typically HMOs or PPOs that you receive through a private insurance company.
Once you pick out the Medicare drug plan that you want, you have to go to Medicare Plan Finder

and complete your enrollment form. Then you can call the plan provider and also call 1-800-MEDICARE to complete the process.

How to Cover Children in Medicare

In order for children to receive medical care that is sponsored by the government, they must be eligible to receive CHIP or Medicaid.
CHIP
CHIP is the Children’s Health Insurance Program and provides health coverage to about 8 million children in families with incomes too high to qualify for Medicaid but who can’t afford private coverage. CHIP was signed into law in 1997 and provides federal matching funds to states that have CHIP coverage.
CHIP is administered by the states and is jointly funded. States have designed CHIP programs in one of three ways.

  1. Medicaid Expansion
  2. Separate CHIP
  3. Combination CHIP

Some states did not sign up for Medicaid expansion but still have CHIP plans. You can see what states are providing what kind of children health insurance on Georgetown University’s Medicaid and CHIP program finder. Most states have Medicaid expansions, but some states like Florida have their own unique programs.
Medicaid for Children
Medicaid along with CHIP provides health benefits to over 40 million kids in the United States. These are typically low income families who need help with medical expenses. The federal government has set minimum guidelines for Medicaid eligibility, but states have been able to expand coverage under Affordable Care Act. The average income eligibility for children is 241% below the Federal Poverty Level.
Children in families with income over $44,700 a year are now eligible for Medicaid and CHIP in states that have expanded Medicaid programs. However, if you are in a state that did not support Medicare expansion, the average income to qualify per year is $28,000 or less depending on the number of children. You can see if you are eligible and apply for Medicaid through HealthCare.gov
Medicare is designed for individuals who are elderly or who have some kind of disability or condition. Medicaid is designed to take care of children and young dependents. Parents can find out more information about these programs by visiting HealthCare.gov or you can browse MedicarePartC.com for answers to more questions regarding Medicare coverage, eligibility and costs. If you want to sign up for a low cost Medicare plan, you can also speak with us at 1-888-228-MEDI.

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What Isn't Covered in Medicare?

If you are thinking of getting Medicare to help with your medical bills or because you are finally eligible, there are some things you should know about Medicare coverage. Medicare Part A and Part B are included with Original Medicare, and these parts only cover certain costs of medical care. For instance, Medicare doesn’t pay for anything that qualifies as dental. So what isn’t covered Medicare Part A and Part B, and what can you do to get coverage? This guide answers both of these questions.

Medicare Coverage

When you are admitted to a hospital or visit a skilled nursing facility, Medicare Part A hospital insurance covers a certain amount of the costs over a period of time. These costs include:

  • Semiprivate rooms or private room if necessary
  • Regular nursing services
  • All meals, including special diet meals when necessary
  • Special care units
  • Facility drugs, medical supplies and appliances like casts, splints, wheel chairs, etc.
  • Lab tests
  • X-rays
  • Radiation treatment
  • Operating and recovery room stays
  • Some blood transfusions (You pay for the first three)
  • Hospice
  • Rehabilitation services

Medicare Part B is medical insurance that will cover basic medical services that you receive from doctors, laboratories and clinics. The following are services covered by Medicare Part B.

  • Surgery
  • Outpatient medical services
  • Exams like pelvis exams, bone density tests and PAP smears
  • One annual flu shot
  • Annual physical exam
  • Some kinds of oral surgery
  • Behavioral therapy
  • Preventive services
  • Some psychology therapy

All preventive care services are covered, but you may be surprised at the lack of care for your teeth. While some oral surgeries are covered, most dental work is not. Vision, hearing and even podiatry may not be covered.

What’s Not Covered in Medicare Part A

Medicare Part A or hospital insurance will pay for basic services and some specialized needs, but mostly it will only take down part of the cost if you need something special or if you are looking for some kind of extra service like dental. Here is a list of what’s not covered in Part A.

  • Television, radio or telephones in room
  • Private duty nurses
  • Private rooms when not necessary
  • Long-term hospitalization
  • Housekeeping services
  • Non-emergency transportation
  • Personal care or hygiene care
  • Any care received out of the United States

What’s Not Covered in Medicare Part B

Medicare Part B is an extension of Part A and also doesn’t cover all of the services that people may need to visit a hospital or doctor for.

  • Alternative medicine
  • Cosmetic surgery
  • Most dental care
  • Hearing examinations or hearing aids
  • Podiatry
  • Most vision care
  • Any treatment considered ‘not medically necessary’
  • Vaccinations and immunizations
  • Prescription drugs

What Medicare Pays For If You Stay in a Hospital

Medicare Part A also only pas for certain parts of the hospital bill for any amount of time that you visit. In fact, for each event where there is a hospital visit, you must pay a deductible before Medicare pays anything. In 2013, that deductible was $1,184. Deductibles aren’t new with insurance, but it’s important to understand the costs.
Medicare Part A will pay for the first 60 days that you are considered inpatient in a hospital. All of the cost of covered services will be paid for through Medicare. However, once your 60th day in the hospital starts and to the 90th day, you will pay a “coinsurance amount” toward the hospital costs. Medicare only pays the rest of the costs. That coinsurance amount in 2013 was $296 per day.
If you decide to stay longer than 90 days for one event of illness, you can use up to 60 additional days of reserved days of coverage. During these days, you are still responsible for the coinsurance payment each day. You don’t have to use your reserve days for one event of illness. You can always separate them up and use over different benefit periods. However, you will only have 60 days of reserve days for your entire life.

How to Cover the Gaps in Medicare

If you find there are too many gaps with Medicare Part A and Part B, you’re not the only one. Medicare doesn’t cover everything. If you need certain services that aren’t covered, then you may have to pay for them yourself. However, there are a few things that you can do to get coverage if you need a service that isn’t covered by Medicare.
Medigap
To get coverage for co-pays and coinsurance, you can qualify for Medigap if you have Original Medicare. This is a type of insurance sold by private companies that will pay some of the health care costs that isn’t covered in Part A and Part B. It may even cover you if you decide to travel outside of the United States. Each Medigap policy is different, so it’s important to care each of them and find the services that you need.
Medicare Advantage
Medicare Part C combines Part A and Part B as well as extra services through a private health insurance carrier that is approved by Medicare. You can get all of your services covered under Medicare Part C as well as a few extras. For example, many Medicare Advantage plans come with dental and vision services including exams. Each of these plans has different services offered, so it’s best to compare each one to find the list of services that you need. One major advantage of these plans is prescription drug coverage, which is included.
Medicare Part D
Prescription drugs are covered under Medicare Part D, but you aren’t automatically included in the program when you get Medicare Part A and B. You have to sign up separate with Part D with a private health insurance company that is approved by Medicare. This means that you have another card to access your coverage through. Part D is typically included with most Medicare Advantage Plans.
Supplemental Medicare coverage can pay for many of the services that aren’t covered and at least pay for part of the costs so that your out-of-pocket costs are less expensive. You can also use the Medicare coverage tool on Medicare.gov to see if specific services, items and tests are covered.

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Does Medicare Advantage Cover Me If Traveling?

If you have a Medicare Advantage plan, you’re in luck if you travel as some of these plans pay for medical treatment while in foreign countries. Traditionally, Medicare coverage is not available outside of the United States if you have Part A and Part B, but since Medicare Advantage is managed by private healthcare carriers, you may be eligible to have all of your costs taken care of if you need to see a doctor or visit a hospital while not in the US or US territories. So how do you know if you are able to travel with Medicare Advantage coverage? This guide gives you a closer look at how Medicare works when traveling outside of the US.

Medicare Part C May Cover Your Trip Abroad

One of the biggest benefits for anyone with Medicare Advantage is that they can travel and still be seen by a doctor or receive emergency care if something were to happen on their trip. Since retirees often travel, it’s difficult to do so if you only have Original Medicare, which is just Part A and Part B. Some Medicare Advantage plans provide coverage benefits for all health care needs when enrollees go outside of the United States, but it’s best to check with your health insurance company first.

Why Doesn’t Original Medicare Cover Travel

Original Medicare coverage for enrolled travelers is limited. While there are some instances where you can receive medical treatment, the instances of the usage being viable is very small. There are actually only three ways that you may receive care outside of the United States if you have Medicare and need to see a doctor while traveling.

  1. You’re in the US when you have a medical emergency, but a foreign hospital is closer than the nearest US hospital that is able to treat your illness or injury.
  2. you are traveling in Canada with unreasonable delay by most direct route between Alaska and another state when a medical emergency happens. If a Canadian hospital is closer than a US hospital, that hospital can treat your illness or injury. Medicare will determine what “unreasonable delay” means on a case-by-case basis.
  3. You live in the US but a foreign hospital is closer to your home than the nearest US hospital and can treat your medical condition, regardless of whether it is an emergency.

One thing to remember is that if you do encounter these situations, Medicare only pays for the Medicare-covered services that you receive in a foreign hospital.

Does Medicare Advantage Have Limitations on Travel?

If you get a Medicare Advantage plan, then your plan doesn’t always cover medical services while traveling outside of the United States. It depends on what kind of plan you signed up and how long you travel for. It also depends on where you travel and the kind of care that you need while you are traveling.
One thing is certain that if you travel outside of a Medicare Advantage plan’s service are for more than six months, you will likely be disenrolled. Medicare Advantage plans have service areas that are based on the region of where you originally signed up for Medicare. This means that even if you are traveling in the United States, you may be disenrolled from a Medicare Advantage plan unless you notify that you are changing geographic locations. This simply places you in Original Medicare if you are disenrolled from your plan. You also receive a Special Enrollment Period to join a new Medicare Advantage plan if you are disenrolled based on your new geographic location.
Of course, not all plans have that policy to disenroll their members. You will receive notification if that is the case from your healthcare carrier. Some plans also include benefits to allow people to stay on a plan even if they are traveling long-term.

Do I Need Travel Health Insurance?

If you are planning to travel for an extended period of time or if you know that you don’t have coverage through Medicare or Medicare Advantage, then it’s best to purchase a travel health insurance policy to go with you on your stay. these are supplemental coverage policies that will provide for your medical care if you need to see a doctor or visit a hospital while traveling outside of the US.
In some cases, you can find Medigap policies for those with Medicare that will allow you to travel outside of the United States and still get coverage. A Medigap policy pays for the costs that Original Medicare plans do not cover. Medigap is not available if you are enrolled in a Medicare Advantage Plan.

Do I Still Have Coverage When I Return to US?

If you are traveling outside of the United States for an extended period of time, you may be disenrolled from your Medicare Advantage plan and placed back into Original Medicare. When this happens, you will receive a notification, and you will continue to pay the Part B premium. If you drop Part B and do not pay for your Medicare, then you will have to pay an enrollment penalty when you come back to the United States. Premiums are set to increase each year by 10 percent when not enrolled in Part B. It’s important that you continue to maintain your health insurance even if you decide to travel for longer periods of time outside of the United States.
Medicare Advantage plans are a great option if you plan to travel. If you want to switch to a Medicare Advantage plan for your trip, you just need to go to Medicare.gov or you can use our tools on MedicarePartC.com to find a plan that’s right for your budget and medical needs. As always, you should carefully look at the plan before purchasing to ensure that it will cover you for what you need especially for when you go on vacation outside of the United States.

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How are Medicare Advantage Plans Rated by the Government?

As a branch of the government, Medicare rates plans for their effectiveness for members, but many other factors go into rating Medicare Advantage plans. You can find and compare plans based on rating using Medicare.gov Plan Quality and Performance Ratings tool. Medicare uses various information like member satisfaction surveys, plan quality, health care provider reviews and other facts to give overall performance star ratings. The ratings allow you to compare different plans based on their quality and performance. Plans are rated from one to five stars. If a plan has a five-star rating, it’s considered the absolute best for Medicare Advantage plans.

What Do These Ratings Mean?

There are a range of topics for which Medicare Advantage plans are rated. These include:

  • Staying healthy: How often were members able to get screenings, vaccines and tests that helped them to stay healthy?
  • Managing long-term, chronic conditions: How often were members able to get tests and treatments to manage these conditions?
  • How responsive was the provider of the plan?
  • How many complaints has a certain Medicare Advantage plan provider received?
  • What is the customer service like for the provider of the Medicare Advantage plan?

Prescription drug plans or Part D plans are rated separately if not included in the Medicare Advantage plan. These are rated for the following:

  • Customer service
  • Complaints and Medicare audit findings
  • Member experiences
  • Pricing and safety of available drugs

If a plan has both health and drug coverage, then the overall score is for both.

What is the 5-Star Special Enrollment Period?

The 5-star special enrollment period allows anyone to switch to a 5-star Medicare Advantage plan. These plans may include just health coverage, a combination of health and drug coverage or just drug coverage. You are allowed to use the 5-star special enrollment period one time starting on December 8th and ending on November 30th of the following year. However, this depends on you meeting the plan’s enrollment requirements. You have to live within the service area for the plan, meet requirements regarding age or being eligible based on disability.
If you want to switch to a different plan but already have a 5-star enrollment rating, you can also do so at this time. You can also use the Special Enrollment Period to remove yourself from a Medicare Advantage Plan or Medicare Part D plan to go into an open Medicare Cost Plan with a 5-star rating. This is a type of HMO plan now available to those who are eligible for Medicare.
these plans work in the same way as Medicare Advantage and have the same rules as Medicare Advantage, but if you go to non-network provider, you can still receive coverage under Original Medicare.

Is It Worth the Wait?

Plans with a higher rating are more satisfactory to members, but ratings also take into account the quality of care and prescription drug coverage that members are receiving. Typically, there are only one or two plans per state that have a 5-star Medicare Advantage plan rating. These plans may have more extras and provide comprehensive coverage for other services not covered by other Medicare Part C plans.
In addition, you may lose prescription drug coverage if you switch from a Medicare Advantage plan that has drug coverage to a plan with a high rating but that does not have Part D. You will have to wait until the Open Enrollment period to add drug coverage. In this case, you would also pay a late enrollment penalty.
If you decided to move to a coordinated care plan that is not Medicare Advantage, you will lose any extras and drug coverage that came with the Medicare Advantage plan. In this event, your coverage goes back to Original Medicare.
To make sure that you pick the best plan, you should always compare different plan costs and benefits while also looking at the reviews for different companies offering Medicare Advantage plans in your area. In some cases, companies may still have bad reviews even if a plan has a higher star quality rating.

Understanding Ratings and Special Enrollment

Scenario #1
When Does a Plan Receive a 5-Star Rating?
The ABC Medicare Advantage Plan got an overall rating of 4.5 stars in 2013 but received 5 stars for 2014. Starting on December 8th, 2013, you could have used the Special Enrollment Period to enroll in the 5-star ABC Medicare Advantage Plan that became effective on the first day of January 2014. The plan didn’t have a 5-star rating until 2014, which means that you had to wait until the Special Enrollment period for that year to start.
Scenario #2
When Plan Ratings Change
ABC Medicare Advantage Plan had a rating of 5 stars in 2014 but lost the 5-star rating for 2015. You could use the 5-star Special Enrollment Period to request enrollment in the ABC plan before the first day of the next month until November 30th, 2014. The last effective date is December 1st, 2014. You won’t be able to use the special enrollment period after the first day of December since the plan will no longer have a 5-star rating.

Comparing Plans With Ratings

To compare plans with ratings, you can use tools on Medicare.gov, but MedicarePartC.com also has comparison tools and other guides to help you pick the best plans. You can search for plans in your area and pick plans based on rating, cost and benefits. It’s easy to see what plan offers the best benefits for the price. When you search for plans directly on Medicare.gov, each will provide an “overall star rating” that will give you insight into how that plan compares to other similar plans. Some plans do not have an overall rating yet, which may mean they are not offering the same amount of services as other plans. Some of the highest rated Medicare Advantage plans come from:

  • Aetna
  • CarePlus
  • Humana
  • Blue Cross and Blue Shield
  • Cigna

If you are looking for a high quality Medicare Advantage plan, you should look first at the monthly premium and deductible, then look at the specific health benefits for each plan to compare. Most plans should designate what the out-of-pocket costs will be as well as what type of relationship you’ll have with doctors and medical facilities. In some cases, you will be able to pick your own doctors and facilities. Some plans also include extras like vision and dental yet still have a very low or no cost per month. If you need help picking a plan that’s best for you, contact our staff to get help fast at 1-888-228-MEDI.

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What Preventive Services Are Available Through Medicare?

Getting the most out of Medicare means taking advantage of the services offered to you. The best way to start living a healthy lifestyle is to look at preventive care services. Whether you want to start exercising, eating better, stop smoking or just get help for diabetes, there are a few different ways to use Medicare in your favor. There are many preventive services available through Medicare that allow you to find health problems early and start treatment. To prevent yourself from contracting a serious illness, lab tests, x-rays and screenings can play a major role in getting help. The Affordable Care Act made a lot of necessary improvements to Medicare to ensure that these services were provided at little to no cost to those who are enrolled in Medicare. This article goes over some of the preventive care services that you can receive with Medicare.

Alcohol Misuse, Screening and Counseling

Adults who have Medicare including women who are pregnant can receive help for alcohol dependency. Medicare covers one alcohol misuse screening every year. You can also receive up to four face-to-face counseling sessions, and a qualified medical doctor or practitioner must provide any counseling to you. You don’t pay anything if you go to a primary care doctor or other primary care practitioner who accepts the assignment.

Bone Mass Measurements

If you believe you have osteoporosis or just fear that you have a broken bone, Medicare also covers screenings to check your bone density. These tests give you valuable insight into keeping your bones strong. This service is provided to anyone whose doctor believes they are at risk for osteoporosis and have one of these conditions:

  • Estrogen-deficient and at-risk osteoporosis patients
  • Vertebral abnormalities shown on x-rays
  • Anyone receiving steroid treatments
  • Hyperthroidism
  • Persons who are taking osteoporosis drugs

Measurements can occur once a year on average but also may be used when necessary. You don’t pay anything for this service.

Breast Cancer Screenings

Breast cancer is the second leading cause of death by cancer in women in the US. All women are at risk, and risks increase with age. However, it can be treated successfully when found early. Women who are 40 and over are eligible for a mammogram every year. Medicare also covers a baseline mammogram for women between 35 and 39. You don’t pay anything for these screenings.

Cardiovascular Disease Screening and Behavioral Therapy

Anyone with Medicare can be screened for cardiovascular disease once every five years. You can also receive behavioral therapy including screenings for high blood pressure, discussing aspirin to help with risks and counseling to achieve a better diet. You also receive tests for cholesterol, lipid and triglyceride levels. The screenings and behavioral therapy are free.

Cervical and Vaginal Cancer Screening

Medicare covers Pap tests and pelvic exams that are necessary to diagnose and treat cancers of the cervix and vagina. Medicare also covers clinical breast exams. All women are eligible for these cancer screenings. You don’t pay anything for the Pap test or pelvic exam. These tests and exams are particularly important to anyone who has had an abnormal Pap test and if you began having sex at an early age or have engaged with multiple partners.

Depression

Anyone with Medicare can receive help for depression. You receive one depression screening every year, and it’s free as long as you see a primary care physician and follow up with your treatment. The screening may also offer you referrals for counseling and medication to help with symptoms of depression.

Diabetes Screening

Medicare offers a lot of help for anyone with Medicare who is at risk for diabetes. Medicare also covers self-management and educational training to help with diabetes problems. Up to 2 diabetes screenings are free each year. However, you pay 20% of the cost for a Medicare-approved approved amount after your Part B deductible for the self-management training.

Glaucoma Tests

Glaucoma is an eye disease that is caused by high pressure in the eyes. It develops over time without warning and doesn’t show any symptoms. The best way for individuals who might be at risk for this disease is eye tests. Medicare covers one glaucoma test every year. You pay 20% of a cost that is approved by Medicare after your annual Part B deductible. You are more at risk for glaucoma if you have diabetes, family history of glaucoma, African-American heritage or Hispanic heritage and you are 65 or older.

HIV Screening

Anyone who asks for an HIV screening can receive one per year or up to three times during a pregnancy.

Medical Nutrition Therapy

If you have diabetes or kidney disease, or your doctor requests this service, then you may receive help from a dietitian or nutrition professional. Nutritional assessments and counseling are covered to help you manage your diet. You receive three hours of one-on-one counseling in the first year and two years for each year after that. You may be able to get further hours of treatment if your condition worsens.

Obesity Screening and Counseling

For anyone who is overweight, Medicare covers intensive behavioral therapy. Your body mass index must be 30 and over. Counseling is also covered by this service. You receive one face-to-face counseling visit each week in the first month of your treatment, then you receive one visit every other week for the second month through the sixth month. After that you receive one visit every month as long as you are losing weight. You may receive more counseling visits if you have more trouble losing weight. You don’t pay anything for these services.

Prostate Cancer Screening

Doctors can help individuals find prostate cancer by testing the amount of Prostate Specific Antigens in the bloodstream. Doctors can also perform digital rectal exams. All men with Medicare who are over 50 can receive these screenings. You can receive a digital rectal exam once every 12 months and a PSA test once every 12 months. You pay 20% of the Medicare-approved costs for the digital rectal exam, and you don’t pay anything for the PSA test.

Sexually Transmitted Infection Tests and Counseling

Anyone with Medicare who is pregnant or anyone who is at risk for STIs can receive screening and counseling through Medicare for free. However, your primary care doctor must order the tests and counseling.

Free Shots

Medicare covers all kinds of free shots to prevent flu, pneumococcal and Hepatitis B. You can receive flu shots once every flu season. Pneumococcal shots are available once in your life for free. For Hepatitis B, three shots are needed. You need to speak with a doctor to see if you are eligible.

Tobacco Use Counseling

If you want help to quit smoking, Medicare covers counseling sessions as long as you haven’t been diagnosed with an illness caused by tobacco use. Medicare covers 8 face-to-face visits that must be given by a qualified doctor. You don’t pay anything for these services.

Yearly Wellness Exam

You also receive one free wellness exam every year through Medicare just to make sure that you are in a good health.
For more information and for a longer list of preventive care services, you can view the Preventive Services Checklist on Medicare.gov.

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What are some of the benefits to having Medicare Advantage over Original Medicare?

Medicare encompasses so many healthcare plans in one program. While this gives eligible members a lot of different options, it can also be confusing if you don’t know what Medicare program is best for your medical needs and budget. If you already have signed up for Medicare or don’t have Medicare yet, there are a few different options that you may want to look at. Medicare Advantage (Medicare Part C) is one of the alternatives to choosing Original Medicare (Medicare Part A and Medicare Part B). Many people choose Medicare Part C because it gives them better options for healthcare, but here are some specific benefits.

1. Medicare Part C is Different

Simply put, Medicare Part C is different than Original Medicare or Part A and Part B. It’s your own plan that you select from private health insurance companies. You get to pick a plan that has everything you need and probably some extras to cover vision and dental. Medicare Part C is still Medicare, however, which means you are still receiving aid from Medicare and are protected by those rights and benefits.
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2. New Options with Medicare Part C

Medicare Part C is also called Medicare Advantage, and true to its name, there are some other advantages to picking your own plan. Health insurance companies must offer the same benefits or better as Medicare Part A and Part B. Since these companies receive help from Medicare to offer these plans at a discount, they typically include some extras such as vision, wellness programs, dental, prescription drug coverage and even hearing aid programs. If you want more options for a lower price Medicare plan, Medicare Advantage will likely have a few different choices and you can pick a plan from some of the best health insurance providers.

3. Medicare Advantage Prescription Drug Coverage

One of the biggest benefits of all is that with most Medicare Part C plans, prescription drug coverage is included. This means that you receive generic drug prescriptions at a great discount. You can also get brand name drugs in some private health insurance plans though it may cost a higher premium. Most prescription drug coverage can also be added for just $12 a month with some private Medicare Advantage plans. If you require a prescription regularly, you could actually be getting your medication for much less each month.

4. Easier and Simple Payments

While you may not have to pay anything with some Medicare Advantage Plans, most likely you will pay a small premium. If you get Original Medicare, you will pay separately for Part A, Part B and Part D. You will have different cards for each plan. It can be very confusing. Another benefit of Medicare Advantage is that you have just one payment and one card. You don’t have to spend a whole lot of time figuring out where the payment is going and when you have to pay it. You work with a private health insurance company, and if you choose one of the better and more advanced companies out there, you can check all of the information on your policy online and even make payments instantly from your phone.

5. Foreign Emergency Coverage

Medicare Advantage plans in most private health insurance companies include some form of “home away from home” healthcare, which means that you can always get emergency healthcare even when you are travelling out of the country. If you plan on heading out to a different part of the world, you always want to protect yourself, which is why so many seniors switch to Medicare Advantage in order to get covered while taking some adventurous tours In South America. You definitely don’t want to be without coverage wherever you go.

6. The Average Cost of Medicare Advantage is Low

Most enrollees pay around $60 a month for Medicare Part C plans. While you have to include Part B in your payment, many are eligible for tax credits and discounts so they don’t have to pay Part B premium or it’s at a very low cost. You can also compare many of the plans from private insurance companies online. This allows you to pick and choose exactly what coverage you need and plan accordingly for your budget. It can be difficult trying to figure all of this information out on the Medicare.gov website. You can always use MedicarePartC.com if you want to compare plans.
How to Compare Medicare Insurance Plans

  • Will the plan cover your preferred healthcare providers?
  • What are the costs of co-pays, premiums and other out-of-pocket charges?
  • What are the deductible amounts?
  • Are there any coverage restrictions?
  • Are hospital stays and skilled nursing facilities included?
  • Does it have prescription drug coverage?

7. Medigap is Complicated

If you are thinking of supplementing your policy with Medigap coverage, it’s actually more complicated to do this rather than just switching to Medicare Part C. If you qualify for Medigap coverage, then you might have to pay an addition premium separately for using this coverage, which would create another payment plan. While private companies do offer Medigap insurance policies, they are not as comprehensive as Medicare Part C. They only offer some additional coverage for services that you should already receive with Medicare Part A and Part B, but you don’t. If you want a real all-in-one type of Medicare plan, then the only option is Medicare Part C. This way all of your payments cover your medical costs, doctor visits and prescription drugs.

8. Some Plans Include Fitness Club Memberships

Like to work out? Private insurance companies are picking up on incentives to offer members of Medicare Advantage. Free gym memberships are regularly included in Medicare Advantage plans along with other incentives because it gives you another reason to choose their insurance over another. As with any health insurance plan, you should read the different benefits and look at the fine print before deciding on any coverage that may change your healthcare in a way you don’t like.
One thing to remember is that Medicare Advantage plans must include all of the services offered in Original Medical plans. This means that preventive care, doctor’s visits, emergency care, skilled nursing facilities, lab tests and more. You can always come to MedicarePartC.com to look at different questions or find answers on some of the confusing parts of Medicare.

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How Do You Choose the Right Medicare Plans for Your Parents?

The idea of picking the right Medicare plan for yourself seems simple enough, but what if you had to do it for someone else? Trying to pick Medicare plans for your parents can be a little confusing. Did you know that 77 million people were born between 1946 and 1964? These individuals are known as baby boomers, and it’s likely that your parents are one of them. If you have a parent that may become eligible for Medicare or is already eligible, they can learn all about Medicare and compare plans online. They can even apply for Medicare plans online, which is much simpler than mailing in a form or going to the Social Security Office. If you want to know more about picking a Medicare plan for your parent, these are some tips to follow.

Types of Medicare Plans

There are actually a variety of Medicare plans. Most people think that Medicare is just one health insurance program that encompasses all of a person’s medical needs. Actually, Medicare breaks down into multiple parts or plans.
Original Medicare includes

  • Part A – Hospital Insurance covers in-patient hospital care, skilled nursing care, home health care and hospice care.
  • Part B – Doctor’s visits, blood tests, x-rays and outpatient care.

Medicare Advantage

  • Part C – Medicare Part C plans cover Medicare Part A and Part B, but they also include extras like prescription drug coverage, vision and dental. These plans are offered privately through major health insurance companies. They typically have a low cost or may cost nothing. You still have to pay Part B premium if you choose Medicare Part C. You have one insurance card and pay one insurance company.

Medicare Part D

  • Part D – Prescription drug coverage covers generic drugs for Original Medicare, but with Medicare Advantage, you may be able to get free generic drugs and discounted premium drugs. Prescription coverage is offered separately for those who have Medicare Part A and B, but it’s typically included with Medicare Part C.

Baby Boomer Facts
Medigap

  • Medigap – This is supplemental coverage to take care of services that Original Medicare recipients don’t have. You cannot get Medigap if you have Medicare Advantage.

Special Needs Plans

  • SNPs – Special Needs Plans are only for certain people who qualify for this type of insurance based on their disability.

Typically, you will choose between Original Medicare and Medicare Advantage. MedicarePartC.com offers multiple articles with comparisons on these plans.

HMO, PPO or PFFS

Most Medicare plans will break down into Health Maintenance Organizations, Preferred Provider Organization or Pay-a-Fee-For-Service plans. These are known as HMO, PPO and PFFS. There are slight differences between these plans that might narrow the decision on what type of Medicare to choose for mom and dad.
Original Medicare

  • PPO: Medicare operates like a PPO, but you can only see doctors, providers and hospitals that accept Medicare. You pay a monthly premium that is around $104 for Part B and typically do not have to pay for Part A. You can pick up a Medigap plan to cover your deductible and coinsurance.

Medicare Advantage

  • HMO, PPO or PFFS: Medicare Advantage Plans are offered by private companies, which means that they offer a variety of different Medicare plans. Most of these plans are HMOs, which means that you will have to choose a primary care physician and have managed healthcare.
  • If you choose a PPO, then you can pick the doctor who you want to see and go to the facilities that you want to go to, but they have to accept your plan and you may pay a fee for going outside of the network. For example, your co-pays may be higher.
  • If you go with a PFFS plan, then you just have to make sure that a doctor or hospital accepts that type of insurance policy. Some do not accept Medicare Advantage. However, you can pick the doctor and hospitals that you want to see.

Costs of Each
– Original Medicare

  • Medicare is free for some individuals who do not earn enough or who paid into the program long enough.
  • You may have to pay for Medicare Part A, but most likely you will just pay your Part B premium. In some cases, you will have a deductible.
  • You pay for prescription drugs or may qualify for Part D insurance separately.
  • You may want to get Medigap to supplement your out-of-pocket costs like deductibles.

– Medicare Advantage

  • Some Medicare Advantage plans are offered free through private health insurance companies, but you still have to pay a Part B premium in most cases.
  • Only private insurance companies approved by Medicare can provide coverage, which means that you have to pick from their approved insurance providers.
  • Extras like gym memberships, prescription drug coverage, dental and vision are most likely included
  • Co-payment and co-insurance will be paid by you ni some cases.
  • Plans vary depending on the carrier.

– Part D or Prescription Drug Coverage

  • If you have Original Medicare, then you will pay a monthly premium and pick a separate Medicare Prescription Drug Plan through a private health insurance company.
  • If you have Medicare Part C or Medicare Advantage, then prescription drug coverage is typically covered by your plan. You can still join a Medicare Prescription Drug plan separately if your health insurance carrier doesn’t provide it.

The costs with each plan will most likely depend on your lifelong earnings, total income from last year’s tax return, how many are in your household, degree of health, disabilities and spouse information. You may qualify for free Medicare.
– Medigap Policies

  • These policies vary in cost depending on the company.
  • You can supplement Medicare Part A and Part B plans with this coverage.

You may want to check with your parents’ employer to see if they are covered in retirement for health costs. You can also use the Eligibility Calculator on Medicare.gov.
Medicare Advantage is strongly encourage for those who like to be in control of their own health plans and want the option of going with a major health company rather than the government. There are many issue with the Medicare program, but it’s actually been reformed and provides a variety of ways for people who can’t afford healthcare to receive medical treatment and have a regular doctor. If you want to learn more about Medicare, we offer a variety of different compare tools and videos to check out.

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I'm turning 65, what happens to my old health insurance coverage?

A person first becomes eligible for insurance through Medicare when they turn 65 years old, receive Social Security (SS) or Railroad Retirement Board (RRB) benefits or are diagnosed with End-Stage Renal Disease or Lou Gehrig’s Disease. For people who are simply turning another day older, the fact that they are now eligible for health insurance through Medicare may not be a life-changing occurrence because they are presently insured by an employer or through their spouse’s insurance policy. But the option to get healthcare from Medicare is available and so long as the person continues to comply with the requirements of the Affordable Care Act, which mandates that all American citizens have healthcare coverage that meets a minimum standard, a newly of-age person should rest assured that the ability to hop onto a Medicare plan will is still there.
Medicare requires that newly qualified people to the program sign up for healthcare as soon as they become eligible. If a person does not sign up for insurance through Medicare, either through the Social Security Office for a Medicare Part A and/or Part B plan or through a private insurance company for a Medicare Advantage, which is also known as a Medicare Part C plan, there may be a penalty imposed for waiting.
The question is, if a person has health insurance either through their employer or through their spouse when they turn 65 and opt not to get healthcare coverage through Medicare immediately, as required by Medicare, will they be penalized when they do get healthcare coverage through Medicare?
The short answer is no.
The Medicare program supports people who recently turned 65 and are now eligible for Medicare coverage, who choose to keep the coverage paid for by their employer or their spouse’s employer because it saves the Medicare program, which is partially funded by the federal government, money. The period of time that a person who just turned 65 years old chooses to keep their other insurance coverage in lieu of signing up for a Medicare policy creates an exception to the mandatory enrollment period.
Let’s discuss the enrollment period a little further. If a person chooses to sign up for a Medicare healthcare plan when they turn 65, either because they have canceled the plan they had personally or through their employer or their spouse’s employer or because they simply do not have insurance, the enrollment period to sign up without fear of a penalty starts three months before the month that you turn 65 (three months before your birthday month). The mandatory enrollment period also includes your birthday month and the three months after your birthday month. In total, you have a seven-month window to sign up for a Medicare policy. This period of time to enroll applies to any Medicare program.
If a person does not sign up for Medicare during that window of time around their 65th birthday month, they will have another chance to sign up during the general enrollment period, which runs from January 1st to March 31st of each year for Medicare Part A and/or Medicare Part B only. The enrollment period for Medicare Part D and Medicare Part C, which is also known as Medicare Advantage, runs from October 15th to December 7th of each year.
Of course, if you miss the mandatory enrollment period and do not get to sign up for a Medicare policy during the general enrollment period, you will likely be penalized for late enrollment. The penalty will come in the form of a higher premium for Part A and/or Part B plans. Typically, the premiums are increased by 10% and that premium will continuously be charged for two-times the period of time that you were eligible to sign up for Medicare but did not, so long as the period of time was longer than a year. If you sign up for a Medicare Part C (Medicare Advantage) plan instead of a Medicare Part A/Part B plan during the mandatory enrollment period, you will not be penalized.
As discussed previously, if you are still working on your 65th birthday and have coverage from your employer or are still able to be insured by your spouse’s employer when you turn 65 years old, you can disregard the mandatory enrollment period because you will be qualified for a Special Enrollment Period to sign up at a later point without penalty.
This Special Enrollment Period will trigger the month after the person’s employment ends or the healthcare plan with the former employer ends, whichever comes first. The Special Enrollment Period will last for eight months starting on the month after the event occurs. Therefore, if a person’s employment ends in March, they will have eight months starting in April to sign up for Medicare without being penalized. Under these circumstances, a person is not confined by the general enrollment period in order to sign up for a Medicare plan.
Despite the fact that a person has adequate healthcare coverage through their employer or their spouse’s employer when they turn 65 years old, people often sign up for Medicare Part A anyhow. Although the coverage may overlap between a Medicare Part A (hospital insurance) plan and your plan through your employer, there is usually no additional charge or monthly premium to pay for Medicare Part A if that person paid Medicare taxes during their employment, so there is no harm, financial or otherwise, in having both.
Before signing up for Medicare Part A, while still being employed or getting healthcare coverage from your spouse’s employer, you should double check whether your employer is paying into a Health Savings Account (HSA) on your behalf. Oftentimes, an employer will stop paying into the HSA account if you enroll into a Medicare Part A plan.
For those people who do opt to get a Medicare plan and keep their insurance policy through their employer or their spouse’s employer, the two policies will work together to determine which policy will pay a claim first. This situation is a called a “coordination of benefits” and requires the primary payer (oftentimes the private insurance policy) to pay a claim first to their policy limits before passing the remaining amount due to the secondary payer (the Medicare plan) to pay the remaining amount. Of course, whether or not the private insurance policy is considered the primary or secondary payer depends on the circumstances. When you sign up for a Medicare policy, the application will ask several specific questions regarding your employer and the insurance policy through your employer to determine the ranking.

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Are Medicare Plans Available for Veterans?

Many veterans don’t realize that they can take advantage of both Veterans Affairs benefits and Medicare. While you can use both healthcare benefits as a veteran, Medicare and VA benefits don’t work together. For example, Medicare doesn’t pay for the services that you receive at a VA facility. In order for Medicare to adequately cover your healthcare needs, you have to receive medical treatment at a Medicare-accepted facility that is in your plan. If you want to receive VA care, then you have to go to a VA facility.

Which Medicare Coverage for Veterans

Most veterans use VA benefits at VA-designated hospitals. They can use these benefits to get coverage for health care services and items that aren’t included with Medicare. Essentially this means that you don’t have to supplement your medical needs if you have veterans benefits because you can get annual physical exams, hearing aids and over-the-counter prescriptions through your military healthcare plans. However, you may want to consider enrolling in a Medicare Part C plan or Original Medicare plan if you need more healthcare coverage.
Part A and B
Medicare Part A and Part B helps veterans get coverage for services that they need at non-VA hospitals and doctors. Part B covers services that you might need from a provider that is accepted by Medicare. These benefits work outside of VA medical programs. In addition, if you don’t enroll in Original Medicare when you are first eligible, you might receive a Part B premium fee if you decide to sign up later or for each 12-month period that you went without Medicare Part B coverage. There are also gaps in coverage that you might not be covered for.
Medicare Part C
With this type of coverage, you enroll in a Medicare plan through a private health insurance company. These are plans that still place under Medicare rights and protections, but it includes extras on top of the services that you would receive with Medicare Part A and Part B. The advantage of choosing a Medicare Part C plan is that you get to compare more plans and also get more services. While you do have to part Part B premiums, you typically can get all of your services covered in one plan and not have to pay separately for Medicare coverage and prescription drugs that you might need.

I already receive VA benefits. Can I enroll in Medicare?

If you have VA benefits, it’s recommended that you enroll in a Medicare plan as well. You need this coverage to get health care that you won’t receive at a VA hospital. While the two work separately, you can get all of your medical needs covered just by having these two programs on your site. You should probably enroll in Medicare Advantage or Medicare Part C if you want to keep your costs low but also only want to make one payment. There are also more services included with Medicare Advantage plans for veterans. For out-of-pocket costs, you may not have to pay copayments for doctor’s visits or on prescriptions with a Medicare Part C plan.

How Prescription Drugs Work with VA Benefits and Medicare

You generally don’t need prescription drug coverage if you have VA benefits as these should be included in your VA health plan. However, if you are having trouble getting the right prescription drugs or you want more options, it’s best to find a Medicare plan that can help you get the prescriptions that you need in a timely fashion. In truth, veteran prescription drug coverage is better than Medicare, and you don’t have to pay a penalty if you don’t enroll in Medicare Part D or prescription drug coverage.

Benefits of Medicare for Veterans

If you live far away from a VA facility or aren’t getting the healthcare that you require, it’s a good idea to sign up for Medicare if you are eligible. You become eligible for Medicare if:

  • You are 65 or older
  • Qualify for disability
  • Have an illness like End Stage Renal Failure
  • If your spouse receives Medicare

Those who receive Medicare also have the following benefits:

  • Free or low cost healthcare coverage
  • Low out-of-pocket costs
  • Wide choice of doctors and hospitals
  • Prescription drug coverage
  • Extra services like vision and dental if you pick Medicare Advantage
  • Free doctor’s visits, exams, gym memberships and other perks through Medicare Part C

You should speak to your VA administrator to learn how Medicare enrollment can help you with your coverage and also ensure that you are eligible for Medicare Part C as well. You can also compare different Medicare Advantage Plans on MedicarePartC.com.

Who Pays First if You Have Va Benefits and Medicare

If you are eligible for both Medicare and VA benefits, then you can receive medical treatment at facilities that accept both programs. However, you must choose which benefits you’ll be using each time that you go to see a doctor or receive any type of treatment. Medicare won’t be able to pay for some services that are only available through VA facilities, so it’s important that you check what type of coverage you have and how it can be used with veterans healthcare plans.
If you want the US Department of Veterans Affairs to pay for your medical treatment, then you have to go to a VA facility or have VA allow you to get services at a non-VA hospital or rodctor.
Medicare will pay the bill at a non-VA hospital if you can’t get coverage for all of the treatment that you received. Medicare will part for the part of the services that your other benefits don’t cover. Medicare may also be able to pay your co-payment for care that you are authorized for through veterans benefits but only if you go to a non-VA hospital.
In general, veterans should try to receive care first at a Veterans Affairs facility and then try to supplement any costs with a Medicare Plan.

Is Medicare Part C Good for Veterans?

Medicare Part C works like a private health insurance policy. You get all of your treatment from hospitals and doctors who accept Medicare, but your health plan is actually managed through a private health insurance company. You can get HMO, PPO or PFFS with Medicare Part C plans. Each company has these plans, but they are all of different costs. To choose the right one, you should pick a plan that allows you to see your own doctors but also pays for most out-of-pocket costs.

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