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Medicare 2020 – Get the Facts!

Everything You Need to Know for Philadelphia Residents

It’s that time of you year – you need to select your Medicare plan!

Part A covers:

  • Inpatient care in a hospital
  • Skilled nursing facility care
  • Inpatient care in a skilled nursing facility (not custodial or long-term care)
  • Hospice care
  • Home health care

2 ways to find out if Medicare covers what you need

  1. Talk to your doctor or other health care provider about why you need certain services or supplies. Ask if Medicare will cover them. You may need something that’s usually covered but your provider thinks that Medicare won’t cover it in your situation. If so, you’ll have to read and sign a notice. The notice says that you may have to pay for the item, service, or supply.
  2. Find out if Medicare covers your item, service, or supply.

Medicare coverage is based on 3 main factors

  1. Federal and state laws.
  2. National coverage decisions made by Medicare about whether something is covered.
  3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.

Part B covers 2 types of services

  • Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
  • Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.

It also covers things like:

  • Clinical research
  • Ambulance services
  • Durable medical equipment (DME)
  • Mental health
    • Inpatient
    • Outpatient
    • Partial hospitalization
  • Getting a second opinion before surgery
  • Limited outpatient prescription drugs

Medicare Supplement Plans or Advantage Plans

Generally, a Medicare health plan:

  • Is offered by a private company
  • Contracts with Medicare to provide Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) benefits
  • Provides these benefits to people with Medicare who enroll in the plan

Medicare health plans include:

  • Medicare Advantage Plans
  • Other Medicare health plans
    • Medicare Cost Plans
    • Demonstrations/Pilot Programs
    • Programs of All-inclusive Care for the Elderly (PACE)
    • Medication Therapy Management (MTM) programs for complex health needs

Your Agent

Your local agent is Greg Gudis. At no cost to you, Greg can help you select the right plan from the choices above!

Greg Gudis BGA Insurance

Greg Gudis – Charted Advisor for Senior Living®

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