This section will provide some information to help you understand what Medicare, state agencies, and/or long-term insurance may be able to pay for and what costs you will be responsible for paying out of pocket.

When any major health event happens to you, it is very easy to feel overwhelmed and blindsided when the bills start coming in. It is important to plan for any major health events, but it is also important not to panic. Many people are concerned about how much their future life plans and health services will cost. Remember, if you have not planned ahead, you still have options. 

Types of Medicare – There are 2 main ways to get Medicare

 

1. Original Medicare
   • Part A – Hospital Insurance
     • Inpatient Care in a hospital
     • Skilled nursing facility care
     • Hospice care
     • Home health care
   • Part B Medical Insurance
     • Medically necessary doctor’s services
     • Outpatient care
     • Home health services
     • Many preventive services
   • Part D – Drug coverage, you can join a separate Medicare drug plan
   • You can use any doctor or hospital that takes Medicare, anywhere in the U.S.
   • To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also shop for and buy supplemental coverage.
   • Covers most medically necessary services and supplies in hospitals, doctors’ offices, and other health care facilities. Does not cover some benefits like eye exams, most dental care, and routine exams
   • In most cases, you don’t need approval for covered services or supplies
   • Generally, doesn’t cover medical care outside the U.S.
      
2. Medicare Advantage (also known as Part C)
   • Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage.
   • In many cases, you can only use doctors who are in the plan’s network
   • In many cases, you may need to get approval from your plan before it covers certain drugs and services
   • Plans may have lower or higher out-of-pocket costs than Original Medicare. You may also have an additional premium
   • Plans may offer some extra benefits that Original Medicare doesn’t cover like certain vision, hearing and dental services.
   • Plans must cover all medically necessary services that Original Medicare covers. Plans may also offer some extra benefits that Original Medicare doesn’t cover – like certain vision, hearing, and dental services.
   • Medicare drug coverage (Part D) is included in most plans.
   • In many cases, you may need to get approval from your plan before it covers certain services or supplies.
   • Plans generally don’t cover medical care outside the U.S.

 

Explore your coverage options. Get information 24/7 including weekends.

 

Medicare.gov

 Call 1-800-MEDICARE (1-800-633-4227)

TTY users can call 1-877-486-2048

Medicare.gov/basics/forms-publications-mailings/forms/other

Medicare.gov/plan-compare

Medicare.gov/medigap-supplemental-insurance-plans

Live chat at Medicare.gov/talk-to-someone

 

What can Medicare pay for?

Examples of what Medicare pays for:

• Physical Therapy (with limits on the number of days)
• Medical Equipment (e.g., canes, walkers, handrails, bedrails)
• Skilled Nursing Facility (after qualifying hospital stay)

 

Department of Veterans Affairs (VA)

Contact the VA if you’re a veteran or have served in the U.S. miliary and you have questions about veteran benefits.

1-800-827-1000

TTY:  711

eBenefits.va.gov

 

What can State Agencies on Aging provide?

Examples of what State Agencies on Aging can provide:

• Low Price Meal Options
• Part-Time Housekeepers (non-medical)
• Transportation to Doctor Visits
• Care Coordination and Social Work Services

 

State Health Insurance Assistance Program (SHIP) Get free, personalized health insurance counseling from your State Health Insurance Assistance Program (SHIP).  More on SHIP below. One of the best resources available across the country for free is the Senior Health Insurance program, also known as SHIP.  This helps people who have Medicare, are preparing for Medicare, or are caring for someone who receives Medicare. 

 

The Mission of SHIP:  SHIP is your local State Health Insurance Assistance Program. SHIP provides unbiased help to Medicare beneficiaries, their families, and caregivers. Whether you are new to Medicare, reviewing Medicare plan options, or have questions on how to use your Medicare, SHIP can help.