YOU ASK:

Do I need health insurance other than Medicare Part A and Part B?

WE ANSWER:

If you want complete protection, then yes, you will need coverage other than Medicare Part A and Part B. You see, Part A is for hospitalization expenses while Part B is for outpatient services - you will still need other health insurance to cover for other needs, such as prescription medicine.

Both Medicare Parts A and B are federally funded and are mostly for those who are 65 years old and above. To be eligible, the Medicare participant (or a spouse) should have paid into Social Security or Railroad Retirement Fund during the time that they are employed.

To give you an idea of what other coverage you need apart from Medicare Parts A and B, here are the items paid by Parts A and B:

Medicare Part A:

Part A is the "basic" or original coverage, upon which you will build and opt for additional benefits and coverage. This mainly provides for medically necessary services.

  • Hospital admission (up to semi-private room)
  • Basic doctor's fees
  • Miscellaneous hospital supplies
  • Nursing home care
  • Skilled nursing facilities
  • Blood transfusions (after the first three pints)

Please note that the coverage is not for long-term care. Enrolment for this is automatic, when you begin receiving your benefits from Social Security, you are already enrolled in this program. Medicare Part A has deductibles of $1,024 for every illness, as well as a co-payment of $256 daily starting from the 61st day of hospitalization up to the 90th day.

Medicare Part B:

  • Medical equipment (walkers, wheelchairs)
  • Physician's fees
  • One-time physical exam
  • Home health service
  • Outpatient surgery (only those medically necessary)
  • Diagnostic laboratory tests (as ordered by the doctor). This includes urinalysis and blood tests.
  • Outpatient mental health services and care
  • Outpatient occupational or physical therapy
  • Medical supplies (glucose control solution, blood sugar testing strips)

Plans A and B will not pay for everything during your hospital stay. You will have to shell out money for deductibles, co-payments or co-insurance. If you are eligible and you think you may have a hard time paying for these, you can also opt to get a Medigap policy to help pay for out-of-pocket costs.

What is important is that you check these plans with respect to your needs and budget to make sure you get a good fit and to know what other plans you may need to have.

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