Medicare Guide

What is medicare?

If you’re over 65, you’ve likely heard about Medicare. It’s a federal health insurance program available for individuals aged 65 and older, some disabled Americans, and those with end-stage renal disease. Medicare covers medical care and hospital bills similar to other insurance plans. Different types of Medicare plans vary in the range and extent of services provided. As a Medicare enrollment provider in San Antonio, Gonzaba Medical Group offers a detailed guide to help you understand the various Medicare plans and their coverage.

It’s crucial for anyone eligible for Medicare to acquaint themselves with the program and its benefits, as these plans can significantly impact the healthcare of elderly or disabled individuals.

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

What does Medicare Part A Cover?

Medicare Part A is your hospital coverage, automatically enrolling you when you apply for Medicare. It covers inpatient hospital stays and nursing care. While doctor’s fees are not included in Part A coverage, certain health services are covered. For instance, Part A covers some home health services, skilled nursing after a hospital stay, and hospice care.
Part A covers testing, supplies, meals, and a semi-private room during a hospital stay. Medically necessary services like physical, occupational, and speech therapy are also covered. Part A also includes coverage for medical equipment like walkers and wheelchairs used in nursing homes.

Most people are automatically enrolled in Medicare Part A, receiving their red, white, and blue Medicare card three months before their 65th birthday or after 25 months of disability. However, some individuals need to sign up for Part A, such as those not receiving Social Security or Railroad Retirement Board benefits, those qualifying for Medicare due to End-Stage Renal Disease, and those wanting to sign up for Part B while residing in Puerto Rico.
As Part A is funded through payroll taxes, there is generally no monthly premium. It covers around 80% of inpatient costs during the first 60 days of a hospital stay, with additional expenses beyond that period. Supplemental insurance plans can help cover these additional costs.

What does Medicare Part B Cover?

Medicare Part B, also known as Supplementary Medical Insurance (SMI), is optional and comes with associated fees. Part B covers outpatient care, preventative services, medical supplies, and some doctors’ services.

This includes coverage for items like:

  • Wheelchairs
  • Canes
  • Scooters
  • Walkers
  • Hormonal treatments
  • Diagnostic tests
  • Blood transfusions
  • Renal dialysis
  • Immunosuppressive drugs after organ transplant
  • Chemotherapy
  • Prosthetic devices
  • Eyeglasses
  • certain vaccines
  • Some ambulance transportation

Preventative and screening services covered by Part B include screenings for:

  • Abdominal aortic aneurysm
  • Alcohol misuse
  • Bone density
  • Cardiovascular disease
  • Cervical and vaginal cancer
  • Colorectal cancer
  • Depression
  • Diabetes
  • Glaucoma
  • Hepatitis C
  • HIV
  • Lung cancer
  • Mammograms
  • Nutrition therapy
  • Obesity
  • One-time “Welcome to Medicare” preventive visit
  • Prostate cancer
  • Sexually transmitted infections
  • Shots
  • Flu
  • Hepatitis
  • Pneumococcal
  • Tobacco use cessation counseling
  • Yearly “Wellness” visit

Individuals with insurance through a union, employer, or spouse may opt out of Part B. However, it’s important to carefully consider all options before making a decision. Those with secure benefits post-retirement may opt out, while others may prefer enrolling to ensure future needs are covered.

What is not covered by Medicare Part A and B?

While the combination of Medicare Part A and Part B covers a wide range of health expenses, it does not cover everything. Some services and items are not covered. You may need to pay for them out of pocket unless you have additional coverage. Even with Medicare-covered services, deductibles, coinsurance, and copayments may apply.

Services and items not covered by Medicare include:

  • Long-term care (custodial care)
  • Most dental care
  • Eye examinations for prescribing glasses
  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and fitting exams
  • Routine foot care