The Basic Parts of Medicare (Parts A, B, C and D)
There are four parts of Medicare. You have likely heard about Original, or Traditional, Medicare, offered by the federal government, which most United States citizens are eligible for at the age of 65. Original Medicare covers Part A and Part B. As you approach eligibility, you may be wondering what Parts Medicare Part C and D are and exactly what each part covers. An overview of each Medicare part is outlined below. Our agents specializing in Medicare can help you better understand how these coverages meets your needs and whether you need additional coverage like Medicare Part C or Medicare Part D.
Medicare Part A: Hospital Insurance
Medicare Part A covers the following:
- Inpatient hospital care
- Skilled nursing facility care
- Nursing home care
- Hospice care
- Some home health services
Medicare Part A is premium-free for most people if you or your spouse worked for 10 years (40 quarters) and paid Medicare taxes. These are some of the cost shares:
- Copays and a $1,556 deductible (per benefit period) apply
- Deductible is not annual—applies per benefit period which starts the day you are admitted to the hospital and ends when you’ve spent 60 consecutive days out of the hospital or skilled nursing care
- Inpatient hospital stays: Days 1-60 covered by Medicare, days 61-90 includes a daily copay of $389
Medicare Part B: Medical Insurance
Medicare Part B covers two types of services – medically necessary and preventative. More specifically, this coverage includes outpatient medical services such as:
- Doctor visits
- Outpatient surgery
- Physical, occupational, and speech therapy
- Mental Health services
- Ambulance services
- Emergency and urgent care
- Immunizations, screenings, and lab tests
- Durable Medical equipment like wheelchairs and walkers
Medicare Part B has a monthly premium and other costs that may apply. The base monthly premium is $170.10 in 2022, but depending on you and your spouse’s adjusted income you may pay more. This is called the Income Related Adjustment. The 2022 annual deductible is $233. After the deductible, you pay 20 percent coinsurance and Medicare pays 80 percent on covered expenses after the deductible.
Medicare Part C: Medicare Advantage Plans
Medicare Advantage plans are Medicare-approved policies offered through private insurance companies. These plans cover everything Original Medicare covers but they may also cover additional items such as dental and hearing aids. Most Advantage Plans include prescription drug coverage.
Your Medicare Advantage may include:
- Plans starting as low as $0/month in premium
- Maximum Out-of-Pocket Limits
- Routine vision and hearing exams
- Worldwide emergency and urgent care
- Dental care
- Wellness programs and fitness programs like Silver Sneakers
To be eligible for a Medicare Advantage Plan, you must live in the plan’s service area and be enrolled in Parts A and B.
Medicare Part D: Prescription Drugs
Once you become Medicare eligible, you are required to have what is referred to as creditable coverage. This can be through your employer plan (make sure it qualifies), the VA, a Medicare Advantage plan or a standalone Part D prescription plan. Even if you don’t have any prescriptions, you still need a prescription plan. Coverage is not automatic and a late enrollment penalty may apply if you delay enrollment once you’re first eligible and go without creditable coverage for more than 63 days.
Part D drug plans cover most prescription drugs you get from the pharmacy. Your Part D coverage can either be part of a Medicare Advantage Plan or purchased as a standalone plan if you are staying on Original Medicare. Prescription drug plans may include a monthly premium if you purchase it as a standalone prescription drug plan.
Prescription drug costs vary based on the plan’s:
- Formulary – a list of covered drugs
- The tier – the level designated by the carrier which determines its cost
- What stage of Part D you are in – deductible, initial, (donut hole) or catastrophic
Your agent can explain which companies cover your prescriptions at the lowest cost. Because formularies and cost shares can change annually, it is vital to review this information with your agent during the annual enrollment. Our team can go over your Medicare options and go over how Medicare works. In addition we can look up your drugs on formularies, check your doctors for network participation and help you determine what Medicare coverage is most appropriate.
Call our Medicare Division at 860-379-2885 or email ann@bowenagencyllc.com for an appointment.