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Clearing up Medicare mysteries

By Meredith Cohn

The Baltimore Sun (MCT)

Published: Monday, May 5 2014 10:04 a.m. MDT

A: Medicare does not cover most outpatient prescription drugs. There is some limited specific coverage of medications under Medicare Part A and Medicare Part B. Medicare offers prescription drug coverage to everyone with Medicare. A Medicare Part D Prescription Drug Plan or Medicare Advantage Plans offer prescription drug coverage. Medicare Part D plans are run by Medicare-approved private insurance companies. Not all medications are covered by all the Part D or Medicare Advantage Plans. Visit the Medicare plan finder at the federal website Medicare.gov, and do a search to determine whether your medications are covered and to find out the plan cost.

Q: Do Medicare Part A and B and Medigap supplemental plans have separate premiums?

A: Many people receive Medicare Part A (hospital) coverage free of charge if they have worked the appropriate number of quarters under Social Security. Most people pay a monthly Medicare Part B (medical) premium ($104.90 monthly in 2014). Medigap, Medicare Advantage and Medicare Part D premiums are paid to the private insurance company sponsoring the plan.

There are several financial assistance programs available for people who meet specific eligibility criteria to help pay for Medicare Part A premiums, deductibles and co-payments; Medicare Part B premiums and deductibles; Medicare Part D premiums and prescription drug co-payments; and Medicare Advantage costs.

Q: How do you find the best doctors and specialists who take Medicare?

A: Ask your medical providers if they accept Medicare and if they accept Medicare-assigned payments. The Medicare website, Medicare.gov, lists doctors and specialists in your area and whether they accept Medicare assignment.

Q: Does Medicare cover nursing home care?

A: Medicare covers semiprivate rooms, meals, skilled nursing and rehabilitative services, and other medically necessary services and supplies after a three-day-minimum medically necessary inpatient hospital stay for a related illness or injury. There are co-payments and limits on the number of coverage days for nursing home care. To qualify for care in a skilled nursing facility, your doctor must certify that you need daily skilled care like intravenous injections or physical therapy. Medicare doesn’t cover long-term care or custodial care.

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