Medicare: How It Works and How It Doesn't

What is Medicare:
Medicare is a government run health insurance program for:
People age 65 or older
People under 65 with certain disabilities
People of any age with End-Stage Renal Disease

Medicare has 2 parts:
Part A: Inpatient hospital care
     Yearly deductible of $876
     +228/day for days 61-90
     +456/day for days 91-150
Part B: premium $66.67/month
     Yearly deductible of $100
     + 20% copayment for most services
Things to be aware of:
Doctor, health care provider or supplier must be enrolled in Medicare program. If not part of program can charge up to 15% more than Medicare's approved amount and does not apply to supplies and equipment. Medicare will not pay for any supplies or prescription drugs supplied by an unenrolled supplier.

Doctor or supplier should give you a written nice called an ABN (Advance Beneficiary Noice) when you are to receive supplies or services not covered by Medicare unless these items or services are never covered by Medicare. You have 120 days to appeal to Medicare if you feel that the services should have been covered.

Not Covered:
Most wellness services such as yearly checkups
Most Screening Tests
Dental Care
Eye Exams and eyeglasses
Hearing Aids
Cosmetic Surgery
Routine foot care and flat foot care
Health services outside of US
Prescription Drugs
Medigap (Medicare Supplement Insurance)
A policy sold by private insurance companies to help cover those areas "the gap" not covered by Medicare. Medigap policies must follow federal and state laws. It may be illegal for someone to sell you a Medigap policy if you are in a Medicare Advantage Plan. Medigap plans are standardized by the governement. There are 12 Medigap plans presently offered Plan A through Plan L. Each insurance company that offers a plan must provide the same benefits covered in the plan but each insurance company can charge whatever they want for the coverage. ie. coverage is the same but the prices will vary by insurance company so it is good to shop around. Note* you cannot buy and it is illegal for an insurance company to sell you a medigap insurance policy if you are in a Medicare Advantage Plan (like a HMO, PPO, or PFFS).

Best time to enroll is during the open enrollment period which is the 6 month period after you turn 65 or the six month period after you enroll in Medicare Part B. This has many advantages including shortening waiting period on pre-existing conditions. Cannot be dropped from Medigap unless fail to pay premiums, misrepresented information or insurance company goes bankrupt
Not Covered by Medigap
Long-term care
Vison or dental care
Hearing aids
Private-duty nursing

Medicare Advantage Plan also called Medicare + Choice Plans
These are plans sold by private insurance companies that reflect more traditional health insurance plans. They generally fall into 3 categories
HMOs (manged Care Plans)
PPOS (Preferred Provider Plans)
PFFs(Private Fee-for-Service Plans)

Medicaid
This is a program for people with limited income and resources and covers more than Medicare but varies by state.

PACE
PACE combines medical, social, and long-term care services for frail people. Requirements are 55 or older and requiring nursing home level care.

Medicare Coverage
There are Medicare Coverage Chart  available that list services covered and amount of copayments. In general is something is covered you usually have to pay 20% of the Medicare approved payment.

Medicare Prescription Dug Plans