Learning about Medicare can be like learning a new language.
Let's Learn the Basics...
Much like learning a new language when learning about Medicare you need to learn the words, understand the main ideas and become fluent in Medicare. But first things first: We’ll start by learning the Medicare basics.
The basic Parts of Medicare:
There are four basic parts of Medicare: A, B, C and D. Each part helps pay for certain health care services. Each part also has certain costs that you may have to pay. Your Medicare costs will depend on what coverage your choose and on what health care services you use.
The parts of Medicare are like puzzle pieces that can be put together in different ways to provide coverage based on your needs.
Medicare Part A
Medicare Part A coverage is hospital insurance. It’s one part of what’s often called Original Medicare, which is administered by the federal government.
What Does Medicare Part A Cover?
Medicare Part A covers the hospital charges and most of the services you receive when you’re in the hospital. But it doesn’t cover the fees charged by doctors who participate in your care while you’re in the hospital.
What Does Medicare Part A Cost?
Medicare Part A shares some costs with you if you need to be hospitalized. The table below shows the different costs that may apply. Costs are shown for 2020.
You do not have to pay a premium for Part A if you or your spouse worked and paid Medicare taxes for at least 10 years.
Medicare Part B
Medicare Part A coverage is medical insurance. It’s one part of what’s often called Original Medicare, which is administered by the federal government.
Medicare Part B helps pay for care you receive in a clinic or hospital as an outpatient. Part B also covers most doctor services you receive as a hospital inpatient.
What Does Medicare Part B Cover?
Medicare Part B covers doctor visits and most routine and emergency medical services. It also covers some preventive care, like flu shots. The list below shows more examples of what Part B covers.
What Does Medicare Part B Cost?
Medicare Part B shares some costs with you when you see the doctor or use other medical services.
Part B charges a monthly premium. The payment is deducted from your monthly check if you receive Social Security benefits. Otherwise you need to send a monthly premium payment to Medicare. Plans vary depending on the provider.
How Medicare Part B Cost Sharing Works
Medicare Part B pays 80% of the cost for most outpatient care and services, and you pay 20%. But there is something called “Medicare assignment” that’s important to understand.
Doctors and providers who accept Medicare assignment agree to take what Medicare pays—the Medicare-approved amount—as payment in full. Medicare reduces the approved amount it pays for doctors who don’t accept Medicare assignment.
Doctors who don’t accept Medicare assignment may charge more than the Medicare-approved amount. You may have to pay the additional cost, which is called “excess charges.”
Please note: Parts A & B of Medicare DO NOT COVER PRESCRIPTION DRUGS.
Medicare Part C
Medicare Medicare Part C is also called Medicare Advantage. It’s an alternative to Original Medicare (Parts A and B).
Part C plans are offered by private insurance companies approved by Medicare. You must be enrolled in both Part A and Part B to join a Medicare Advantage plan. You are still enrolled in the Medicare program, but you will receive your benefits through the Advantage plan instead of through Original Medicare.
What Does Medicare Part C Cover?
Part C, or Medicare Advantage, plans combine coverage for hospital care, doctor visits and other medical services all in one plan. Plans are required to provide all of the benefits offered by Medicare Parts A and B (excluding hospice care, which continues to be provided by Part A). Depending on the plan they may also cover expenses, such as prescription drug coverage and additional benefits like routine dental and eye care exams.
What Does Medicare Part C Cost?
Part C, or Medicare Advantage, coverage is specific to the plan you choose. Each plan sets its own specific costs, but the types of costs they include are similar to those included in parts A & B. You will need to look at the details of any particular Medicare Advantage plan for actual costs and coverage.
How Medicare Part C Cost Sharing Works
Most Medicare Advantage plans (Part C) use a combination of deductibles, co-insurance and co-pays to share the cost of the services you use. Cost-sharing usually applies to all of the services the plan covers.
You need to read the details of each individual Medicare Advantage plan to get the full story on its costs. Most plans have network doctors and pharmacies that may offer plan members discounted pricing.
Medicare Part D
Medicare Part D is prescription drug coverage. It helps pay for the medications your doctor prescribes.
Many people who choose Original Medicare add a prescription drug (Part D) plan or choose a Medicare Advantage plan that includes Part D.
In general, you may enroll in a Part D plan if you are entitled to Medicare Part A or if you are enrolled in Medicare Part B. In addition, you must also live in the service area of a Part D plan.
What Does Medicare Part D Cover?
Medicare Part D Plans are required to cover certain common types of drugs, but each plan may choose which specific drugs it covers. The drugs you take may not be covered by every Part D plan. You need to review each plan’s drug list to see if your drugs are covered.
Prescription drug plans do not cover:
- Drugs that are not on the plan’s drug list
- Drugs that are covered under Part A or Part B
- Drugs that are excluded by Medicare
What Does Medicare Part D Cost?
The insurance companies that offer Medicare Part D drug plans and Medicare Advantage (Part C) plans with drug coverage set their own prices, but the types of costs they include are similar.
Part D plan premiums and cost sharing can vary widely, even for similar coverage. You need to review plan details carefully as well as drugs covered to see which plan is the right fit for you.
How Medicare Part D Cost Sharing Works
Medicare Part D has different stages of cost sharing until you reach a set limit on out-of-pocket costs for the year. The limit is $4,020 in 2020. After that, your plan pays most of the cost of your drugs for the rest of the year.
Co-pays, co-insurance amounts and your plan deductible, if any, count as out-of-pocket costs. Premium payments do not.
- You pay for your drugs until you reach the deductible amount set by your plan.
- Not all Part D plans have a deductible.
- If your plan does not have a deductible, your coverage starts with the first prescription you fill.
For more specific information about coverage. Contact us.