Medicare in the state of Pennsylvania is a federal health insurance program which will pay for a variety of health care expenses. It is administered by the Centers for Medicare & Medicaid Services, which is a division of the U.S. Department of Human & Health Services. Medicare beneficiaries are typically senior citizens aged 65 or older. Adults with ceratin approved medical conditions such as Lou Gehrig’s disease or qualifying permanent disabilities may also be eligible for Medicare benefits.
Similar to Social Security, Medicare is an entitlement program. Pennsylvania residents like most U.S. Residents will earn the right to enroll in Medicare by paying taxes and working for a minimum required period. Even if a person does not work long enough to be entitled to Medicare benefits, may still be eligible to enroll however; they may have to pay more.
There are four different Medicare programs that are known as Part A, Part B, Part C, and Part D. Parts A & B are often called Original Medicare. Medicare Part C is private Health Insurance and Part D will offer coverage for prescription drugs.
Medicare Part A is hospital insurance. It will cover hospice care, inpatient hospital care, limited home health care services, and limited time in a skilled nursing.
Most Medicare Part recipients in Pennsylvania do not have to pay a monthly premium to receive coverage under this part of the Original Medicare; this is called premium free Part A. Generally, if you have worked for at least 10 years and paid Medicare taxes while working, you are eligible for premium-free part A. Otherwise the recipient will have to pay monthly premiums.
Medicare Part A recipients typically will not cover the full amount of their hospital bill, so they will probably be responsible for a share of the costs. You will also have to pay a deductible before Medicare benefits begin. Medicare will pay 100% of your costs for up to 60 days in a hospital or up to 20 days in a skilled nursing home. After this, the beneficiaries will pay the flat amount up to the maximum number of covered days. Your Medicare Part A benefits will cover some of these costs for a total of 90 days in the hospital and 100 days in a skilled nursing home. Medicare will also cover up to 60 “lifetime reserve days.” These are the days the beneficiaries stayed in a hospital longer than 90 days in a row. They will get a lifetime total of 60 reserve days.
Medicare Part B is medical insurance. Part B will cover certain non-hospital medical visits, outpatient hospital care, diabetic screenings and supplies, X-rays, blood tests, and doctors’ office visits. The recipients will pay a monthly premium for this part of the Original Medicare. This fee can be higher if a person has a high income. A different government program, Medicare, can help cover Medicare part B premiums for low income households.
Medicare Part B beneficiaries are responsible for a portion of their health care costs. They will pay a small deductible each year before their Medicare Part B benefits kick, and then they will generally pay 20% of their bill when they visit a participating Medicare doctor. Medicare will pay the full cost of many services and lab tests that is requested by their doctor.
Medicare Part C or Medicare Advantage, insurance will often include every type of Medicare coverage in one health plan. It is offered by private insurance companies that are contracted through CMS to provide Medicare benefits package as the alternative to Original Medicare. Medicare Advantage is optional, but to obtain this private insurance, a person must also have Original Medicare, Part A and Part B. You also may continue to pay your Part B Premium if you have a Medicare Advantage plan.
While Medicare Advantage plans are required to provide all Medicare Part A and Medicare Part B benefits (except hospice care), plans may include different additional benefits, which vary among the individuals private health insurers. Many Medicare Advantage plans include prescription drug coverage. Some plans could have lower deductibles, while also allowing you to pay a smaller share of any remaining costs. Medicare Advantage plans may even cover certain health care services that Original Medicare, Part A and Part will not cover such as dental care, eye exams, hearing aids or any health care received while traveling outside of the U.S.
Medicare Part is an optional prescription drug coverage. It is available as a stand-alone plan that is through private insurance companies, and the monthly fees will vary among the insurers. You will share the costs of your prescription drugs according to the plan you are enrolled. The costs can include a flat copayment, a percentage of the full drug costs (called “coinsurance”) or a deductible.
If a person wants prescription drug coverage, they can get it through a Medicare Advantage plan if there is one in their area which offers this coverage. If you cannot afford medications or have a limited income even though you currently receive Medicare Part D benefits, you may qualify for the Extra Help program that will offer financial assistance for your monthly coinsurance, copayments, premium, and deductible.
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