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What Is Medicare, and What Does It Cover?

Medicare is a government health insurance program that helps seniors and people with disabilities pay for some of their medical costs. It is an important safety net for millions of Americans, and it can be very helpful in reducing healthcare costs. This blog post will discuss what Medicare is, what it covers, and how to apply for it.

As mentioned above, Medicare is a government-run health insurance program that provides coverage for Americans aged 65 and older and those with certain disabilities. It is an important safety net program, and millions of people rely on it for their healthcare needs. It boasts more than 40 million enrollees and a large network of suppliers, making it difficult to navigate those outside the health insurance system. It is one of the oldest government-sponsored healthcare programs in the United States, instituted in 1965 as a pilot program. Today, Medicare serves as America’s basic social safety net, protecting people long accustomed to receiving benefits without reciprocity, thanks in part to persons who volunteer their time and effort to provide assistance beyond federal guidelines.

What does Medicare Cover?

Medicare covers a number of healthcare services, including:

1. Hospitalization

This includes both short-term acute care and long-term nursing facilities. All patients must meet a set of criteria to qualify for hospitalization under Medicare (including age, income level, and other factors). The amount paid by Medicare for these services varies depending on location, type of service provided, and other factors. Hospitals are reimbursed at varying rates. These payments may not cover all of the charges associated with your stay; you should expect to receive additional funds from Medicare if they do not fully compensate your provider. For example, if you have received $4,000 for treatment but only paid $3,000 out-of-pocket, then you would owe Medicare the remaining balance. You can get up to 100 days of hospice care per year using Medicare Part A. Medicare also pays for outpatient surgery. However, payment depends largely upon the ability of the doctor or hospital to prove the need for reimbursement.

2. Physician Services

These include visits to doctors’ offices, physical therapy services, home healthcare visits, and prescription medicines. Medicare usually covers 80 percent of physician fees. If you have supplemental insurance through work, check any limitations regarding the use of Medicare. It also covers most dental, vision, hearing aids, and eyeglasses. These services are usually billed separately from hospital bills. If necessary, Medicare will reimburse dental providers at 90 percent of the usual fee charged by private dentists rather than 100 percent. Coverage for hearing aid devices is limited to those over 65 years old. Vision and eyeglass benefits are available to individuals over age 65. But there are exceptions to the rules – some drugs used to treat glaucoma may not be covered, as may hearing aids.

3. Home Health Care

If you require skilled nursing services at home, Medicare offers coverage for qualified providers. This typically entails hourly home health aides (HHA) who provide personal care such as bathing and dressing, light housekeeping duties, transportation, and meals prepared by a certified dietitian. Some HHA services extend to caregivers who assist residents in activities of daily living (ADLs), which are needed to remain independent. Other HHA services may include medication management, wound care, skin treatments, and rehabilitation therapies. Generally, Medicare will pay for up to 120 days of home health care services each year. You should contact your local agency before applying for this benefit. In addition to Medicare coverage, Medicare supplements offer additional help when paying medical bills. Many employers offer their retirees a supplemental plan through a defined contribution or CD plan. Others choose to pay a fixed monthly premium towards a retiree’s health expenses. It would be best if you enrolled in Medigap plans offered by insurers licensed to sell them to qualify.

4. Prescription Drugs

Prescription drug coverage is another important part of overall health insurance. While Medicare does not normally cover prescriptions, it does pay for certain commonly prescribed drugs used to treat chronic conditions. If you want to maintain a steady supply of medications, the best way might be to purchase coverage that combines benefits from more than one source. Your employer probably provides some form of prescription drug coverage. Check with ClearMatch™ Medicare about how your coverage works. Contact your State Medicaid office if you are eligible. There are ways to obtain free medicine through community organizations.

5. Dental Benefits

The majority of dental problems can be treated without surgery. However, there are a few cases where dentistry may need to be performed on teeth, gums, and jawbone. Most oral surgeries are considered medically necessary under Medicare rules. Dentures can sometimes be counted as outpatient procedures. The procedure cost ranges anywhere from $400-$1,000. Medicare pays an average of 10-75%, depending on the type of surgery. For example, gum grafting is paid at 75%, while crown restorations are paid at 30%. Since it is unlikely to require multiple dental procedures, you could save money on premiums by purchasing a dental policy that includes all types of dental services and procedures done outside hospitals.

6. Vision Care

If you have been diagnosed with diabetes, certain eye diseases can lead to serious damage or blindness. Depending on the severity of your disease, vision care may also be covered by Medicare Part B. It is rare for a doctor to recommend corrective lenses as these are already included in other benefits like eyeglasses or contacts. Eye exams usually do not fall into the same category as other medical procedures because they generally relate to your general sense of well-being. To qualify for vision care benefits, you must visit an ophthalmologist every two years for a comprehensive examination.

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