Medicare & You Handbook 2020
Medicare & You The official U.S. government
Medicare handbook
2024
2
What's new & important?
Medicare strives to improve access to affordable treatments to keep you healthy. Check out what's new this year to help you manage your health.
Saving money on your prescription drugs If you have Medicare drug coverage (Part D) and your drug costs are high enough to reach the catastrophic coverage phase, you don't have to pay a copayment or coinsurance. Extra Help--a program that helps cover your Part D drug costs-- expanded to cover more drug costs for certain people with limited resources and income. Go to pages 83 and 92. Coinsurance amounts for some Part B-covered drugs may be less if a prescription drug's price increased higher than the rate of inflation. Go to page 40.
Lower costs for insulin and vaccines Your Medicare drug plan can't charge you more than $35 for a one-month supply of each insulin product Part D covers, and you don't have to pay a deductible for it. Go to page 88. If you take insulin through a traditional pump that's covered under Medicare's durable medical equipment benefit, that insulin is covered under Medicare Part B. You won't pay more than $35 for a month's supply and the Medicare deductible no longer applies. Go to pages 39 and 88. Recommended adult vaccines are also now available at no cost to you. Go to page 50.
Changes to telehealth coverage You can still get telehealth services at any location in the U.S., including your home, until the end of 2024. After that, you must be in an office or medical facility located in a rural area to get most telehealth services. There are some exceptions, like for mental health services. Go to page 51.
Managing and treating chronic pain Medicare now covers monthly services to treat chronic pain if you've been living with it for more than 3 months. Go to page 34.
Better mental health care Medicare now covers intensive outpatient program services provided by hospitals, community mental health centers, and other locations if you need mental health care. Go to pages 46?47.
More times to sign up for Medicare If you recently lost (or will soon lose) Medicaid, you may be able to sign up for Medicare or change your current Medicare coverage. There are other special situations that allow you to sign up for Medicare. Go to page 18.
COVID-19 care Medicare continues to cover the COVID-19 vaccine, and several tests and treatments to keep you and others safe. Go to page 37.
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Contents
What's new & important? .........................................................................................................2 Index of topics.............................................................................................................................. 4 What are the parts of Medicare? ...........................................................................................9 Your Medicare options .............................................................................................................10 At a glance: Original Medicare vs. Medicare Advantage ...........................................11 Get started with Medicare...................................................................................................... 13 Get help finding the right coverage for you...................................................................14 Section 1: Signing up for Medicare .....................................................................................15 Section 2: Find out what Medicare covers ..................................................................... 25 Section 3: Original Medicare ................................................................................................ 57 Section 4: Medicare Advantage Plans & other options .............................................61 Section 5: Medicare Supplement Insurance (Medigap) ........................................... 75 Section 6: Medicare drug coverage (Part D)................................................................. 79 Section 7: Get help paying your health & drug costs ................................................91 Section 8: Your Medicare rights & protections ............................................................ 97 Section 9: Get more information ..................................................................................... 107 Section 10: Definitions .......................................................................................................... 119
Need information in an accessible format or another language? Go to pages 123 and 125?126.
Symbol key Look for these symbols to help you understand your Medicare coverage.
Compare: Shows comparisons between Original Medicare and Medicare Advantage Plans.
Important!
Important: Highlights information that's important to review.
Cost & coverage: Gives you information about costs and coverage for services.
Preventive service: Gives you details about preventive services.
New! New: Highlights what's new in this year's "Medicare & You."
Helps you find important information on .
4 Index of topics
Index of topics
A
Abdominal aortic aneurysm30 Accessible Communications123 Accountable Care Organization (ACO)29,
51, 74, 103, 110?111, 119 Acupuncture30, 87 Advance Beneficiary Notice of
Non-coverage101 Advance care planning30?31, 35, 55 Alcohol misuse screenings & counseling31 Ambulance services31, 53 Ambulatory surgical centers31?32 Amyotrophic lateral sclerosis (ALS)15 Appeal28, 59, 65, 87, 97?101, 108, 113 Artificial limbs49 Assignment29?33, 35?36, 38?43, 45,
47?48, 50, 54?55, 58, 59?60, 65, 119
B
Balance exam42 Barium enema35 Behavioral health integration services32,
87 Beneficiary and Family Centered
Care-Quality Improvement Organizations100, 113 Benefit period27, 29, 119 Benefits coordination22, 89, 90, 113 Bills23?24, 59, 82, 89, 99, 105 Blood26, 32?33, 35?36, 38?39, 43, 45, 76 Blood-based biomarker test36 Blue Button?59, 105, 109 Blue Button 2.0?59, 109 Braces (arm, leg, back, neck)49
C
Cardiac rehabilitation33 Catastrophic coverage81, 83 Cervical and vaginal cancer screenings33 Chemotherapy34, 65 Chiropractic services34 Chronic care management services34 Chronic pain management and treatment
services34 Claims25, 58?59, 99?100, 102?105, 109 Clinical research studies27, 34, 61 COBRA18?19, 89 Cognitive assessment35, 55 Colonoscopies35?36 Continuous Positive Airway Pressure (CPAP)
devices, accessories, & therapy36 Coronavirus disease 2019 (COVID-19)37,
49, 50 Cosmetic surgery56 Cost Plan. Go to Medicare Cost Plans. Costs (copayments, coinsurance,
deductibles, and premiums) Extra Help paying for Part D92?94 Medicare Advantage Plans64?65 Original Medicare58?59 Part A and Part B22?24, 25?56 Part D late enrollment penalty83?85 Counseling to prevent tobacco use & tobacco-caused disease36 Coverage determination (Part D)99?100 Covered services (Part A and Part B)25?55 Creditable prescription drug coverage64, 79, 81, 83?85, 89, 94, 119
Note: The bold page numbers have the most details.
D
Defibrillators38 Dementia35, 55, 70 Demonstrations/pilot programs74, 120, 121 Dental care and dentures10, 12, 55, 56, 62,
67, 75, 95 Department of Defense113 Department of Health & Human Services.
Go to Office for Civil Rights. Department of Veterans Affairs84, 90, 114 Depression32, 35, 38, 46, 55 Diabetes34, 38?39, 42, 46, 51, 70 Dialysis (kidney/renal dialysis)16, 31, 44?45,
51, 65, 66, 98, 108 Disability15?19, 21, 30, 54?56, 91, 96, 103,
124 Drug coverage (Part D)79?90
Appeals97?101 Coverage under Part A26?29 Coverage under Part B39?40 Join, switch, or drop80?81 Medicare Advantage Plans61?65 Drug plan Costs81?85 Enrollment80?81 Types of plans79 What's covered85?88 Drugs (outpatient)39?40 Dual eligibles (Medicare-Medicaid plans)70, 94?95 Durable medical equipment9, 26, 29, 39, 40, 44
E
EKG/ECG41, 52 Electronic handbook14, 63 Electronic Health Records111 Electronic Medicare Summary Notices
(eMSN)59, 109 Electronic prescribing112 Emergency department services41
Index of topics 5
Employer group health plan coverage Costs for Part A may be different26 Drug coverage80, 84, 88 How it works with Medicare21 Medigap Open Enrollment77
End-Stage Renal Disease (ESRD)16?17, 21, 31, 42, 44, 51?53, 64, 70, 74, 98
Enroll Medicare Advantage Plans (Part C)63?64 Medicare drug coverage (Part D)80?81
Extra Help (help paying Medicare drug costs)79, 81, 83, 88, 92?94, 96, 113, 120
Eyeglasses41, 55, 75
F
Fecal occult blood tests35?36 Federal Employee Health Benefits (FEHB)
Program89 Federally Qualified Health Center
services41, 46 Flexible sigmoidoscopies35?36 Flu shot42, 50, 54, 122 Foot care39, 42 Formulary81, 85?86, 88, 99, 120 Fraud86, 103, 105?106
G
General Enrollment Period18, 23, 71, 80 Glaucoma screening42
H
Health Insurance Marketplace?18, 19, 20 Health Maintenance Organization (HMO)
Plan61, 64, 66 Health risk assessment55 Health Savings Accounts (HSAs)20 Hearing aids42, 56, 75 Hepatitis B shot42?43, 50 Hepatitis C screening43 HIV screenings43 Home health care/services9, 25?26, 29, 44,
100, 108 Home infusion therapy services &
supplies40, 44
Note: The bold page numbers have the most details.
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