Medicare is the federal health insurance program for people aged 65 or older, certain people with disabilities, and people with End-Stage Renal Disease. There are four different parts to Medicare that cover different services.
Medicare Part A covers hospice care, care in a nursing home, hospital stays, and some home health care. You can get premium-free Part A if you or your spouse worked for at least ten years and paid Medicare taxes for all that time. If you don’t qualify for free Part A, you can still buy it by paying a monthly premium. Part A will cover the costs of a semi-private hospital room, meals during your stay, general nursing care, any drugs you need as part of your inpatient treatment, and other hospital services and supplies. However, Part A won’t pay for private nursing, a TV or phone in your hospital room, or personal care items like razors, slippers, or socks.
Medicare Part B covers doctor visits, outpatient care, preventative services, ambulance services, durable medical equipment, and some home health care and preventative services. Part B helps pay for services like doctor visits, outpatient hospital care, medical equipment, physical therapy, and some home health care that Part A does not cover. Part B also covers preventative services including screenings, vaccines, and yearly “Wellness” exams.
You pay a monthly premium for Part B coverage. The standard premium amount changes yearly depending on your income. You also pay a yearly deductible before coverage begins, as well as 20% coinsurance for most covered services.
Another way to get your Original Medicare coverage (Parts A and B) is through Medicare Part C, also known as Medicare Advantage. Private insurance companies approved by Medicare offer Medicare Advantage plans. With Part C, you still have Medicare but you receive your Part A, Part B, and usually Part D coverage from a private insurer instead of the government.
Medicare Advantage plans must cover all the services that Original Medicare covers, but they can have different costs and restrictions. Plans vary in their monthly premiums, copayments, deductibles, and provider networks. Unlike Original Medicare, many Medicare Advantage plans also offer extra benefits like hearing, vision, and dental care.
If you’re wondering what is Medicare Part D?, it provides prescription drug coverage. Private insurance companies approved by Medicare offer Part D plans. You pay a monthly premium on top of your Part B premium for Part D coverage. You also pay copayments or coinsurance when filling prescriptions. Costs vary widely based on your plan and the drugs you take.
To enroll in Part D, you must already have Original Medicare or a Medicare Advantage plan. Part D helps cover some of your prescription drug costs, but it does not cover all drug costs. You will typically still have some out-of-pocket costs for your medications. Part D fills gaps in prescription drug coverage, but it does not eliminate all drug expenses.
In short, Original Medicare consists of Part A and Part B. Part A covers inpatient and hospital care while Part B covers outpatient care and medical services. Part C, Medicare Advantage plans, offer an alternate way to get your Part A and B coverage from private insurers. Part D provides prescription drug coverage to help lower your medication costs. Each part of Medicare helps cover different healthcare services and has its own costs and rules. Understanding the different parts can help you choose the right Medicare coverage option.