Medicare Guide


What is medicare?

If you are over 65 years old, the word “Medicare” has certainly come up in conversation. Medicare is a federal health insurance policy that is available for those over the age of 65, some disabled Americans, and those with end-stage renal disease. This program pays for medical care and hospital bills, same as other types of insurance. There are several types of Medicare, which differ from each other in both scope and breadth of services provided. As a Medicare enrollment provider in San Antonio, Gonzaba Medical Group brings you the detailed medicare guide to help you understand various Medicare plans and their scope.

Anyone who may qualify for Medicare should take the time to familiarize themselves with the program and what benefits it offers. These programs can make a huge difference to an elderly or disabled person’s healthcare.

For more information on Medicare, please call our Patient Hotline.

What does Medicare Part A Cover?

Medicare Part A is your hospital coverage. When you apply to Medicare, you are automatically enrolled in Part A. This part will cover your inpatient hospital stays and nursing care. While doctor’s fees do not fall under your Medicare Part A coverage, some health services do. For instance, Part A will cover some home health services, skilled nursing after a hospital stay and hospice care.

During your hospital stay, Part A will cover testing, supplies, meals, and a semi-private room. As long as it is deemed medically necessary, Medicare Part A will cover physical, occupational, and speech therapy. Medical equipment like walkers and wheelchairs used inside a nursing home are also covered under Part A.
Many people are automatically enrolled in Medicare Part A. If you are, then you will receive your red, white and blue Medicare card in the mail either 3 months before your 65th birthday or after 25 months of disability.

Some people do need to sign up for Medicare Part A, however. If the following situations apply to you, then you will have to sign up for Medicare Part A on your own.

You are not receiving Social Security or Railroad Retirement Board (RRB) benefits.
This can occur if you are still working.
You qualify for Medicare because you are in End-Stage Renal Disease (ESRD).
You want to sign up for Part B and live in Puerto Rico.
You must already have Part A to apply for Part B.
Since Medicare Part A is funded using payroll taxes, you generally do not need to pay a monthly premium. Part A will cover around 80% of your inpatient costs during the first 60 days of hospital stay. After that period of time, you will have to pay a share of the costs. Supplemental insurance plans come into play here.

What does Medicare Part B Cover?

Medicare Part B is also known as Supplementary Medical Insurance (SMI). Unlike Part A, Part B is optional. Since it is voluntary, there are fees associated with signing up for Medicare Part B. There is a monthly premium and patients have to meet an annual deductible prior to coverage taking effect. Premium rates are higher for those with higher incomes.
Medicare Part B helps with outpatient care, preventative services, medical supplies and some doctors’ services. Medical supplies are things like wheelchairs, canes, scooters and walkers. Certain hormonal treatments, diagnostic tests, blood transfusions, renal dialysis, immunosuppressive drugs after organ transplant, chemotherapy, prosthetic devices, eyeglasses, certain vaccines, and some ambulance transportation are covered by Part B.

You may want to opt out of Part B if you have insurance through a union, employer or spouse. Prior to making a decision, it is important to weigh all your options. Those who can count on strong benefits after they retire may want to opt out. Those who are less secure often choose to enroll in Part B prior to leaving the workforce to ensure their needs down the road are taken care of well.

What preventative and screening services are covered by Medicare Part B?

Medicare Part B covers many preventative and screening services. These include, but are not limited to:

Abdominal aortic aneurysm screening
Alcohol misuse screening & counseling
Bone mass measurement (bone density)
Cardiovascular disease screenings & behavioral therapy
Cervical & vaginal cancer screening
Colorectal cancer screening
Depression screening
Diabetes screening & self-management training
Glaucoma tests
Hepatitis C screening test
HIV screening
Lung cancer screening
Nutrition therapy services
Obesity screening & counseling
One-time “Welcome to Medicare” preventive visit
Prostate cancer screenings
Sexually transmitted infections screening & counseling
Tobacco use cessation counseling
Yearly “Wellness” visit

What is not covered by Medicare Part A and B?

While the combination of Medicare Part A and Part B should cover most health expenses, it doesn’t cover everything. What Medicare does not cover will most likely have to be paid out of pocket, unless you have additional coverage. Even with Medicare covered services and items, you will most likely have to pay deductibles, coinsurance, and copayments.

Some of the items and services that Medicare doesn’t cover include:

Long-term care (also called custodial care)
Most dental care
Eye examinations related to prescribing glasses
Cosmetic surgery
Hearing aids and exams for fitting them
Routine foot care