The Ultimate Guide to Medicare
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The Ultimate Guide to Medicare
Medicare has several parts. Medicare Parts A and B are the original components. Parts A and B are Federally provided coverage to help with medical expenses, generally for those who are 65 and older.
Medicare Parts C and D, along with Medigap, are supplemental coverage that can be purchased to compliment original Medicare.
- Medicare Part A – Hospital Insurance
- One part of Original Medicare coverage. It helps pay for inpatient hospital, skilled nursing facility, hospice, and home health care.
- Medicare Part B – Medical Insurance
- The other part of Original Medicare. It helps cover doctors’ services, outpatient care, and home health care, as well as the cost of certain preventative services to help you maintain your health and keep certain illnesses from getting worse.
- Medicare Part C – Medicare Advantage
- Offer health coverage options run by private insurance companies approved by and under contract with Medicare. These plans includes all benefits under Part A and Part B, with minor exceptions, and usually includes additional benefits, such as dental, vision, and drug coverage.
- Medicare Part D – Prescription Drugs
- Additional prescription drug coverage that helps cover the cost of prescription drugs and may even help protect against higher costs in the future. It is run by private insurance companies approved by and under contract with Medicare.
What is Medicare Part A?
Medicare Part A is health insurance for hospital-related expenses. It is provided by the United States government to citizens and legal immigrants over 65.
If you are over 65 and have worked for a least 10 years paying Medicare taxes, you qualify for premium-free Part A coverage.
You can still buy into Medicare Part A if you are over 65 but don’t qualify for the premium-free version. Additionally, certain disabilities can qualify you before the age 65
Benefits of Medicare Part A include:
- Hospital stays
- Nursing care
- Home-health care
Medicare Part A qualifies as minimum essential coverage. It satisfies the law that requires people to have health insurance.
What is Medicare Part B?
Medicare Part B is outpatient insurance. It is provided by the United States government to citizens and legal immigrants over 65.
Individuals who are eligible for premium-free Medicare Part A are also eligible to enroll in Part B.
Benefits of Medicare Part B include:
- Doctor’s visits
- Emergency ambulance services
- Lab work
- Outpatient surgeries
- Preventive services
- Medical equipment
What is Medicare Part C (Medicare Advantage)?
Medicare Part C plans are often called Medicare Advantage plans or MA plans.
These Medicare-approved private insurance plans are for people already enrolled in Medicare Part A and Part B.
They offer all the benefits of Medicare Part A and B, plus additional services for a premium.
Additional Benefits usually included in Medicare Part C
Prescription drugs are covered separately in Medicare Part D but may be packaged with the purchase of a Medicare Advantage plan.
What is Medicare Part D?
Medicare Part D provides prescription drug coverage that is supplemental to those with Medicare Part A and Part B.
Original Medicare doesn’t cover most of your medications. Part A covers drugs you get as a hospital inpatient only. Part B covers drugs you get as an outpatient, in very limited cases, like infusion drugs.
Medicare Part D covers a much wider of Prescription Drugs taken at home.
The drugs that are covered by a Medicare Part D plan and their pricing are listed in the plan’s formulary, which you can request before purchase.
What is Medigap (Medicare Supplement)?
Medicare Supplement, or Medigap, is additional private insurance that helps pay for the “gaps” in Medicare Part A and B.
Individuals with Medicare Part C (Medicare Advantage), cannot get a Medigap plan.
General Benefits of a Medigap plan
- Routine vision or dental care
- Hearing aids
- Private-duty nursing
There are currently ten different types of Medigap plans, and each state approves a set of coverage options. These plans vary in their coverage, deductibles, and premiums. Choosing the right one can take a lot of research.
See our guide for more information. Learn more about Medigap plans
Medicare’s Annual Election Period, also known as the Open Enrollment Period happens each year from October 1 to December 7. It’s during this time that millions of beneficiaries will make changes to existing coverage or sign up for new plans. If you are a Medicare beneficiary, the Annual Election Period is an important time to pay close attention to changes in plans, including coverage and premiums, for the following year.
Must-know Facts About Open Enrollment
When choosing your health coverage through Medicare, you should remember that Part A is hospital insurance and will protect you if you need to make a trip to the emergency room, or are admitted and must spend a few days under hospital care or in a nursing facility. Part B medical coverage and is what you need when making a trip to the doctor’s office.
Medicare Advantage plans, offered by private insurance companies, are another way to receive all of your Part A and Part B benefits, and it may also provide additional benefits, such as prescription drug coverage. If you have medications due to health conditions, you’ll want to make sure you have Part D coverage, either through a Medicare Advantage plan that offers it, or a stand-alone Medicare Prescription Drug Plan.
Each year, Medicare sends out an Annual Notice of Change to give you a list of changes that are taking place to your current plan, including information about copayments and premiums for next year. The notice also compares benefits for the next year, so it’s important to consider any changes in health conditions or needs. Insurers can change the drugs covered under Part D, procedures, rates, and even networks on a yearly basis.
Any beneficiaries who aren’t satisfied with their current plans offerings for the next year can switch now. You can join a Medicare Advantage or Part D plan for the first time, or unenroll from your current coverage and go back to Original Medicare.
Of course, anyone who is pleased with their current coverage, and wants to keep the same coverage for the following year, doesn’t need to make any changes during open enrollment for Medicare.
Warnings to Medicare Beneficiaries
With this open enrollment season comes the chance that you may run into fraud. If someone comes to your door and offers to sell you anything to do with Medicare, don’t let them in. They aren’t allowed to solicit business at your home if they don’t have an appointment with you. You should also refrain from giving out personal information such as your Social Security number, Medicare ID, and bank account or credit card numbers.
Medicare Tips for Seniors
For seniors and other individuals looking to make changes during the Medicare Annual Election Period, here are some tips to ensure that they don’t get confused about insurance requirements:
- The Annual Election Period opens October 15 and closes on December 7. If you choose to make plan alterations, your new coverage will begin on January 1 of the following year.
- Seniors should know Medicare isn’t a part of the health insurance marketplace under the Affordable Care Act. If you have Medicare, then you’re covered under the new regulations and won’t be required to purchase a separate plan.
- Review your Annual Notice of Change and Evidence of Coverage during open enrollment to make sure changes made to your current plans will not affect you negatively next year. If they do, you may want to go with a different plan, or if your health needs have changed and will no longer be met, you may need find one that will suffice.
- Part B premiums generally change each year, with new premiums announced in the fall. This is the same for Part A premiums, if you are required to pay one, as well as deductibles and other costs associated with Original Medicare. Knowing all of your Medicare costs will help you make better decisions about any additional coverage you may need.
- Beneficiaries with a Medicare Advantage plan may see changes in premiums, deductibles or copayments. There may also be changes in procedures, doctors and medical facilities that will be covered through your health insurance and some plans may even discontinue service. If this happens, you’ll want to be sure to shop around and find a plan that fits what you’re looking for in coverage. Understanding the details of each Medicare Advantage and determining which one will cover you the best is the most beneficial.
- If you only have Original Medicare, you likely need to get prescription drug coverage if you don’t have any, else pay a late enrollment penalty. You may want to consider enrolling in a Part D Prescription Drug Plan for this coverage and comparing plans during this time to make sure you have the right plan for your medication needs.
Not Eligible for Medicare?
Medicare is generally only for available those who are 65 years of age or older, with some exceptions made for those with disabilities. Medicare recipients also must be citizens of the United States or legal residents.
If you are not currently eligible for Medicare, you still need health insurance. Please look at our guide for how to get health insurance