The ABC’s of Medicare
PART A: HOSPITAL IN-PATIENT HOSPITAL CARE, SKILLED NURSING CARE, AND HOSPICE
Medicare Part A does not have a premium if you or your spouse worked and paid taxes for 10 years or 40 quarters. You must be a US citizen or naturalized citizen that has lived in the U.S. for 5 consecutive years.
- Medicare Part A (Original Medicare)
Part A (hospital insurance) covers hospital stays and inpatient care, including:
- Your hospital room and meals
- special units care; like intensive care
- Drugs and medical supplies used during an inpatient stay
- Lab tests, X-rays and medical equipment as an inpatient
- Operating room and recovery room services
- Skilled nursing services
- Some blood transfusions
- Hospice care, including medications to manage symptoms and pain
- Part-time, skilled care for the homebound after a qualified inpatient stay
- Rehabilitation services after a qualified inpatient stay
PART B: MEDICAL INSURANCE
Medicare Part B is medical insurance and helps pay for services from doctors and other health care providers. This includes outpatient care, home health care, durable medical equipment, and some preventive services.
- Medicare Part B (Original Medicare)
Part B coverage has a monthly premium for most people. In 2020 most people will pay $144.60 per month for this coverage. Those drawing Social Security benefits can have this amount deducted from their monthly check. It’s important to understand that Part B has an annual deductible and once satisfied, Medicare-approved services will pay for 80%, leaving you with a 20% co-insurance.
Medicare Part B coverage includes:
- Doctor visits, including when you are in the hospital
- Diabetes screenings, education and certain supplies
- An annual wellness visit and preventive services, like flu shots
- Mental health care
- Clinical laboratory services, like blood and urine tests
- Durable medical equipment for use at home, like wheelchairs and walkers
- X-rays, MRIs, CT scans, EKGs and some other diagnostic tests
- Ambulatory surgery center services
- Some health programs, like smoking cessation and obesity counseling
- Ambulance and emergency room services
- Physical therapy, occupational therapy and speech-language pathology services
READY TO ENROLL INTO MEDICARE?
PART C: ADVANTAGE PLANS
- Medicare Advantage (also known as Part C)
- Medicare Advantage is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.
- Plans may have lower out-of-pocket costs than Original Medicare.
- In many cases, you will need to use doctors and other providers who are in the plan’s network and service area for the lowest costs.
- Most plans offer extra benefits that Original Medicare does not cover—like vision, hearing, dental, and more.
- Private insurance companies contract with Medicare to offer Medicare Part C plans. These plans must cover everything that Original Medicare (Part A and Part B) cover and may cover extra benefits as well.
- Advantage plans come in a variety of types; HMO, PPO, Private Fee For Service are some common types of Advantage plans. The plans available to you will depend on where you live.
- Advantage plans vary in cost and coverage and are subject to change annually.
- Your Co-Insurance and Co-Pay amounts will vary depending on your plan and specific factors, but most plans do have co-pays and co-insurance costs.
MEDICARE PART D
Part D of Medicare is insurance for your prescription drug needs. These plans are offered through private insurance companies and can be purchased as a stand-alone option with Original Medicare or in conjunction with a Medicare Supplement Plan. Many Medicare Advantage plans include prescription drugs. Keep in mind that there can be a Part D premium penalty for late enrollment.
Things to consider when choosing a Part D plan include:
- Costs; what’s the monthly premium?
- Are my drugs covered?
- How much will my medications cost?
- Are there deductibles that will apply?
- Which pharmacy can I use?
- Formulary structure: in general, the lower the tier, the lower your cost for the drug will be.
Medigap is Medicare Supplement Insurance that helps fill “gaps” in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:
INSURANCE – MEDICARE
How to Get started with Medicare
Getting Medicare is a major milestone.
Check out these 5 important facts:
- Some people get Medicare automatically, and some must sign up. You may have to sign up if you are 65 (or almost 65) and not getting Social Security.
- There are certain times of the year when you can sign up or change how you get your coverage.
- If you sign up for Medicare Part B when you are first eligible, you can avoid a penalty.
- You can choose how you get your Medicare coverage.
- You may be able to get help with your Medicare costs.
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