오리지널 메디케어

Leverage the experience of Brooks Insurance Group to weigh your Medicare coverage options.

Original Medicare is the traditional government-run health insurance program for people aged 65 and older. Certain individuals under the age of 65 with certain disabilities may also qualify. It’s made up of two main parts: Part A, which covers hospital care, and Part B, which covers doctor visits and outpatient services.

Original Medicare is a strong foundation—but it’s important to understand how it works and what additional coverage you may need. Since Part A and Part B only cover 80% of your hospital and medical costs think about enrolling in an additional plan called a Medigap/Supplement plan to help pay the other 20% or enrolling in an Medicare Advantage plan that includes Part A and Part B which does not require a 20% Medigap plan. Not sure where to begin? That’s where we come in.

Qualifications for Those
Under Age 65

• You’ve received Social Security Disability Insurance (SSDI) for at least 24 months.

• You get a disability pension from the Railroad Retirement Board (RRB) and meet specific criteria.

• You receive SSDI due to Lou Gehrig’s disease (ALS).

• You worked in a government job, paid Medicare taxes, and received SSDI for 24+ months.

• You’re a child or surviving (including divorced) spouse over 50 of a worker who paid into Social Security or Medicare-covered government employment and meet SSDI criteria.

• You have end-stage renal disease (ESRD), need dialysis or had a kidney transplant, and meet one of these:

• Worked long enough under Social Security or the railroad retirement system.

• Worked in a Medicare-covered government job.



• Are the child or spouse (including divorced) of a qualifying worker, living or deceased.

65세 이상 자격

귀하가 65세 이상이고 미국 시민이거나 5년 이상 연속으로 미국에 거주한 합법적인 영주권자라면, 다음 상황 중 하나라도 해당되면 Medicare 보장을 받을 자격이 있을 수 있습니다.

• You are currently receiving retirement benefits from either the Social Security Administration or the Railroad Retirement Board (RRB), or you are eligible to begin receiving those benefits based on your work history.

• Your spouse—whether currently living, deceased, or from a previous marriage that ended in divorce—either receives or is eligible to receive Social Security or Railroad Retirement Board benefits based on their own work record.

• 당신이나 당신의 배우자가 사회보장 혜택을 받지 못했더라도, 요구되는 기간 동안 급여세를 통해 Medicare 시스템에 납부한 정부 직책에서 일한 적이 있습니다.

• You are the dependent parent of a deceased child who was considered fully insured under Social Security. This means your child worked long enough to qualify for Social Security benefits before their passing.

Medicare Enrollment Dates

메디케어 가입 자격이 있으시다면, 벌금이나 지연을 피하기 위해 가입 가능 시기를 아는 것이 중요합니다. 주요 가입 기간은 다음과 같습니다.

• Initial Enrollment Period (IEP): A 7-month window starting 3 months before the month you turn 65. Sign up for Parts A, B, C, or D.

• Initial Coverage Election Period (ICEP):
  Your first chance to enroll in a Medicare Advantage (Part C) plan. It usually coincides with your IEP but ends the month before your Part B coverage starts if you delay enrolling in Part B.

• General Enrollment Period (GEP): Runs from Jan 1–Mar 31 each year if you missed your IEP. Coverage begins July 1; late penalties may apply.

• Special Enrollment Period (SEP): Available if you lose coverage, move, or qualify due to other life events. Timing varies.

• Annual Enrollment Period (AEP): From Oct 15–Dec 7, you can switch between Medicare Advantage and Original Medicare or change your drug plan.

• Medicare Advantage Open Enrollment (MA-OEP): From Jan 1–Mar 31, those in a Medicare Advantage plan can switch or drop their plan.

• Medigap Open Enrollment: A 6-month period starting when you turn 65 and enroll in Part B. You can buy a Medigap policy with no medical underwriting.
  

Part A (Hospital) Covers:

Part A helps cover:

Inpatient hospital stays - Part A covers inpatient hospital stays which includes room, meals, general nursing, drugs and other hospital services and supplies. Part A also covers care in a skilled nursing facility, hospice care, and some home health care. 

Part A usually covers inpatient hospital care if you meet both of these conditions:

• 공식적인 의사의 지시에 따라 입원환자로 병원에 입원하게 되었는데, 이 지시에는 질병이나 부상을 치료하기 위해 입원 치료가 필요하다는 내용이 담겨 있습니다.
• The hospital accepts Medicare.

전문 간호 시설 치료 - 메디케어 파트 A는 일반적으로 질병이나 부상으로 입원한 후, 특정 조건을 충족하는 경우 전문 간호 시설에서의 단기 또는 한정 기간 치료를 보장합니다. 전문 간호 시설(주로 요양원)에서의 재활 및 의료 서비스를 포함합니다. 단, 메디케어 파트 A는 요양원에서의 장기 요양 또는 보호 요양은 보장하지 않습니다. 메디케어에서 승인한 전문 간호 치료를 받는 경우, 파트 A는 일반적으로 입원과 관련된 처방약 비용도 보장합니다.

Inpatient Mental Health Services:

Medicare Part A (Hospital Insurance) covers mental health care services you get when you're admitted as a hospital inpatient. Mental health care services help diagnose and treat people with mental health disorders, like depression and anxiety.

• You can get these inpatient services either in a general hospital or a psychiatric hospital (a facility that only cares for people with mental health disorders).
• If you're in a psychiatric hospital (instead of a general hospital), Part A only pays for up to 190 days of inpatient psychiatric hospital services during your lifetime.

홈 헬스케어:

Home health Care is a wide range of health care services that you can get in your home for an illness or injury. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or a Skilled Nursing Facility.

Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) cover eligible home health services as long as you need part-time or intermittent skilled services and you’re “homebound,” which means:

• 질병이나 부상으로 인해 지팡이, 휠체어, 보행기, 목발 등의 도움 없이는 집 밖으로 나가는 데 어려움이 있거나, 특별한 이동 수단이나 다른 사람의 도움을 받지 않고는 집 밖으로 나가는 데 어려움이 있습니다.
• Leaving your home isn’t recommended because of your condition.
• You’re normally unable to leave your home because it’s a major effort.

보장되는 가정 건강 서비스에는 다음이 포함됩니다.

• Medically necessary part-time or intermittent skilled nursing care, like:
• 압박 상처 또는 수술 상처에 대한 상처 관리
• 환자 및 간병인 교육
• Intravenous or nutrition therapy
• 주사
• Monitoring serious illness and unstable health status
• Physical therapy, occupational therapy, and speech-language pathology services (if you meet certain conditions)
• Medical social services
• 다음과 같은 파트타임 또는 간헐적 가정 건강 보조원 케어(숙련 간호 케어, 물리 치료, 언어 병리학 서비스 또는 작업 치료를 동시에 받는 경우에만 해당):
• Help with walking
• Bathing or grooming
• Changing bed linens
• Feeding
• Injectable osteoporosis drugs for women who meet certain criteria
• Durable medical equipment
• Medical supplies for use at home

A doctor or nurse practitioner must assess you face-to-face before certifying that you need home health services. A doctor or a nurse practitioner must order your care, and a Medicare-certified home health agency must provide it.

If your provider decides you need home health care, they should give you a list of agencies that serve your area. They must tell you if their organization has a financial interest in any agency listed.

In most cases, "part-time or intermittent" means you may be able to get skilled nursing care and home health aide services up to 8 hours a day (combined), for a maximum of 28 hours per week. You may be able to get more frequent care for a short time (less than 8 hours each day and no more than 35 hours each week) if your provider determines it's necessary.

요양원 또는 장기요양시설:

요양원은 장기 요양, 상시 의료 및 개인 간병 서비스를 제공하는 주거 시설입니다. 요양원에서 제공되는 대부분의 간병 서비스는 목욕, 옷 입기, 식사 등 일상생활에 대한 도움을 포함하는 보호 서비스입니다. 오리지널 메디케어는 보호 서비스가 필요한 유일한 유형의 간병 서비스인 경우 해당 서비스를 보장하지 않습니다. 그러나 오리지널 메디케어는 질병이나 부상으로 인해 단기간 필요하고 특정 자격 요건을 충족하는 경우, 요양원이나 가정 간병 서비스를 통한 전문 간병 서비스를 보장할 수 있습니다.

Hospice Care -

Hospice Care is end-of-life care for people with illnesses that cannot be cured. Only your hospice doctor and your regular doctor can certify that you’re terminally ill and have a life expectancy of 6 months or less. After 6 months, you can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies (after a face-to-face meeting with the hospice doctor or hospice nurse practitioner) that you’re still terminally ill.

귀하가 메디케어 Part A(병원 보험)에 가입되어 있고 다음 조건을 모두 충족하는 경우 호스피스 케어를 받을 자격이 있습니다.

• Your hospice doctor and your regular doctor certify that you’re terminally ill with a life expectancy of 6 months or less.
• You accept comfort care (palliative care) instead of care to cure your illness.
• 말기 질환 및 관련 질환에 대해 Medicare에서 보장하는 다른 치료 대신 호스피스 케어를 선택하는 진술서에 서명합니다.

If you qualify, you can get hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods. You have the right to change your hospice provider once during each benefit period.

You can usually get Medicare-approved hospice care in your home or other facility where you live, like a nursing home. You can also get hospice care in an inpatient hospice facility. If your hospice care team determines you need inpatient care at a hospital, they must make the arrangements for your stay. If they don’t, you might be responsible for the entire cost of your hospital care.

A부 호스피스 비용

• 메디케어 승인 호스피스 제공자로부터 치료를 받는 경우 호스피스 치료에 대한 비용은 없습니다.
• 통증 및 증상 관리를 위한 외래 약물 처방전당 최대 5달러의 본인 부담금을 납부하셔야 합니다. 드물지만 호스피스 혜택에서 해당 약물을 보장하지 않는 경우, 호스피스 제공자는 해당 플랜에 연락하여 파트 D 보장 여부를 확인해야 합니다. 호스피스 제공자는 보장되지 않는 약물이나 서비스가 있는지, 그리고 해당 약물이나 서비스에 대한 비용을 지불해야 하는지 여부를 알려드릴 것입니다.
• You may pay 5% of the Medicare-approved amount for inpatient respite care (short-term care to help give caregivers a rest). Your copay can’t exceed the inpatient hospital deductible for the year.

Original Medicare will still pay for covered benefits for any health problems that aren't part of your terminal illness and related conditions, but you'll owe any deductible and coinsurance amounts that apply. Once you choose hospice care, your hospice benefit will usually cover everything you need.

You may have to pay for room and board if you live in a facility (like a nursing home) and choose to get hospice care.

호스피스 케어팀에서 입원 치료가 필요하다고 판단하는 경우, 입원 준비를 담당해야 합니다. 그렇지 않을 경우, 병원 치료비 전액을 부담해야 할 수도 있습니다.

Part B (Medical) Covers:

Medicare Part B covers a wide range of outpatient services that are crucial for senior wellness, including:

Medicare Part B (Medical Insurance) helps cover 2 types of services:

• 의학적으로 필요한 서비스: 환자의 건강 상태를 진단하거나 치료하기 위해 허용되는 의료 관행 표준을 충족하는 서비스 또는 용품입니다.
• Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage when treatment is likely to work best.

You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.

Services from doctors and other health care providers

외래 진료

Hospital Observation

방사선과

EKG

MRI Scan

CT 스캔

Ambulance

Annual Wellness Visits

Preventive Services

Physical Therapy

Occupational Therapy

건강 검진:

Preventive Services

홈 헬스케어

Durable Medical Equipment 

Diabetes Pump

연속 포도당 모니터

산소

C-PAP Continuous Positive Airway Pressure

우울증 검진

Mental Health Counseling and Psychotherapy

Obesity Counseling

Smoking Cessation Counseling

Medicare Part B (Medical Insurance) Prescriptions:

Covers a limited number of outpatient prescription drugs under certain conditions. Usually, Part B covers drugs you wouldn't typically give to yourself, like those you get at a doctor's office or in a hospital outpatient setting.

Part B에 포함된 약물의 몇 가지 예는 다음과 같습니다.

• Monoclonal antibodies for the treatment of early Alzheimer’s Disease
• Drugs used with some types of durable medical equipment (DME): If the drug used is medically necessary, Medicare covers drugs infused through DME (like an infusion pump or nebulizer).
• Some antigen allergy tests and treatments: Medicare covers antigen tests to check for allergies and their treatment if a doctor or other health care provider prepares them, and they're given by a properly instructed person (who could be you, the patient) under appropriate supervision.
• HIV prevention drugs.
• 주사형 골다공증 약물.
• 적혈구 생성 자극제: 말기 신장 질환(ESRD)이 있거나 특정 질환과 관련된 빈혈을 치료하기 위해 이 약물이 필요한 경우, 메디케어는 주사로 에리트로포이에틴을 투여하는 데 대한 비용을 보장합니다.
• Blood clotting factors: If you have hemophilia (a genetic bleeding disorder that keeps your blood from clotting properly), Medicare covers injectable clotting factors you give yourself or get in a doctor's office.
• Injectable and infused drugs: Medicare covers most injectable and infused drugs when a licensed medical provider gives them.
• Oral End-Stage Renal Disease (ESRD) drugs: Medicare covers all oral ESRD drugs.

• Enteral and parenteral nutrition (intravenous and tube feeding): Medicare covers certain nutrients if you can’t absorb nutrition through your intestinal tract or take food by mouth.
• 정맥 주사 면역글로불린(IVIG): 다음 두 가지 조건이 모두 해당되는 경우, 가정에서 투여하는 IVIG에 대해 Medicare가 보장됩니다.
• You've been diagnosed with primary immune deficiency disease.
• Your health care provider decides that it's medically appropriate for you.
• B 부분에서는 집에서 IVIG를 구입하는 데 관련된 기타 품목과 서비스 비용도 지불합니다.
• Shots (vaccinations): Medicare covers flu shots, pneumococcal shots and COVID-19 vaccines. Medicare also covers Hepatitis B shots for certain people, and some other vaccines when they're directly related to treating an injury or illness.
• Transplant / immunosuppressive drugs. Medicare covers transplant drug therapy (including certain compounded immunosuppressive drugs) if Medicare helped pay for your organ transplant. You must have Part A at the time of the covered transplant, and you must have Part B at the time you get immunosuppressive drugs. 
• If you only have Medicare because of End-Stage Renal Disease (ESRD) your Medicare coverage (including Immunosuppressive drug coverage) ends 36 months after a successful kidney transplant. Medicare offers a benefit to help you pay for your immunosuppressive drugs beyond 36 months if you don’t have certain types of other health coverage, Group, TRICARE or Medicaid that covers immunosuppressive drugs. This benefit only covers your immunosuppressive drugs and no other items or services. It isn’t a substitute for full health coverage. 
• 경구용 항암제: 메디케어는 경구로 복용하는 일부 항암제에 대해 주사제 형태로 출시되었거나 주사제의 전구약물(prodrug)인 경우 보장을 제공합니다. 전구약물은 경구 투여 형태로, 복용 시 주사제와 동일한 활성 성분으로 분해됩니다.
• Oral anti-nausea drugs: Medicare covers oral anti-nausea drugs you get as part of a cancer chemotherapeutic regimen if you take them before, during, or within 48 hours of chemotherapy, or you get them as full therapeutic replacement for an intravenous anti-nausea drug.
• Self-administered drugs in hospital outpatient settings: Under very limited circumstances, Medicare may pay for some self-administered drugs if you need them for the hospital outpatient services you're getting.

Part D Covers:

메디케어 의약품 플랜(파트 D)은 파트 B에서 보장하지 않는 많은 의약품을 보장합니다. 오리지널 메디케어 가입자라면 메디케어 의약품 플랜에 가입하여 메디케어 의약품 보장 혜택을 받을 수 있습니다. 의약품 플랜에 가입하는 경우, 플랜의 의약품 목록(약전 목록이라고도 함)을 확인하여 보장되는 외래 의약품을 확인하십시오.



D 파트는 일반적으로 예방접종자문위원회(ACIP)가 권장하는 모든 성인용 백신을 포함하며, 여기에는 호흡기세포융합바이러스(RSV), 대상포진, 백일해, 홍역 등 다양한 백신이 포함됩니다. ACIP에서 권장하는 백신에 대해서는 의료보험 플랜에서 본인 부담금이나 공제액을 부과하지 않습니다. 어떤 백신이 본인에게 적합한지 의료 제공자와 상담하십시오.

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