The Area Agency on Aging understands the intricacies of Medicare, and we’re always ready to share our knowledge with you. This pages contains basic information about Medicare, but we encourage you to call us at 937-223-HELP and speak to one of our experts.
Medicare is health insurance for the following:
There are four different parts of Medicare to help cover specific services:
You can choose how you get your health and prescription drug coverage under Medicare.
Medicare Advantage Plans (like an HMO or PPO)
Part A helps cover the following hospital expenses:
If you have a chronic illness or disability, Medicare pays only a small portion of the long-term care you may need in a nursing facility or at home. It does not cover personal or custodial care.
You usually don’t pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working. If you are not eligible for premium-free Part A, you may be able to buy coverage, but in most cases you must also have Part B and pay monthly premiums for both. If you have limited income and resources, there may be help available to pay for Part A and/or Part B expenses.
There are two kinds of Part B covered services:
A list of common services covered under Medicare Part B (both medically-necessary and preventive) is available in the annual Medicare and You handbook.
Costs for Part B services depend on whether you have Original Medicare or are in a Medicare Health Plan. If you choose to enroll in Part B, you pay a monthly premium and an annual deductible. If you have limited income and resources, there may be help available for Part B expenses.
If the Part B deductible applies, you must pay all costs until you meet the yearly Part B deductible before Medicare begins to pay its share. After your deductible is met, you typically pay 20% of the Medicare-approved amount of the service.
A Medicare Advantage Plan (like an HMO or PPO) is an alternative to having Medicare Part A and Part B. They are offered by private companies approved by Medicare and provide all hospital and medical coverage. They are not considered supplemental plans.
Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care, and may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Original Medicare covers hospice care even if you are in a Medicare Advantage Plan. Most include Medicare prescription drug coverage.
Not all Medicare Advantage Plans work the same way, so before you join, find out:
Medicare offers prescription drug coverage to everyone with Medicare Part A and Part B. To get drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.
You can join, switch, or drop a Medicare drug plan at any of the following times:
Exact coverage and costs are different for each Medicare drug plan, but all plans must provide at least a standard level of coverage set by Medicare.
If you have limited income and resources, there may be help available to pay for Part A and/or Part B expenses.
People with limited income and resources may qualify for help paying Medicare premiums, deductibles, and copayments. The income and resource limits change annually, so contact us for current eligibility guidelines and information on the application process.
People with limited income and resources may qualify for Extra Help, also called the low-income subsidy (LIS), to pay prescription drug costs. The income and resource limits change annually, so contact our Information & Assistance Staff for current eligibility guidelines and information on the application process.
If you qualify for Extra Help and join a Medicare drug plan, you will get the following:
Help paying your Medicare drug plan’s monthly premium.
Help paying any yearly deductible.
Help paying coinsurance and copayments.
No coverage gap.
No late enrollment penalty.
You automatically qualify for Extra Help if you have Medicare and meet one of these conditions:
You have full Medicaid coverage.
You get help from your state Medicaid program paying your Part B premiums.
You get Supplemental Security Income (SSI) benefits.
Medicare will mail you a purple letter to let you know that you automatically qualify for Extra Help. You do not need to apply for Extra Help if you get this letter.
You can apply for Extra Help at any time.