Medicare Explained

Are you nearing your age of eligibility and need Medicare explained? You’ve come to the right place.

We’re going to go over exactly what Original Medicare is, a few insurance plans that supplement it, and why those Medicare insurance plans are necessary.

Original Medicare Explained

Original Medicare is Parts A and B.

Part A is Medicare’s inpatient care coverage. 
It covers: 

  • Inpatient care in a hospital
    Care you receive when you’re admitted to the hospital as an inpatient after an official doctor’s order
  • Skilled nursing facility care 
  • Hospice care
  • Home health care

Part B is Medicare’s medical insurance.
It covers: 

  • Medically necessary services: Services or supplies needed to diagnose or treat your medical condition
  • Preventive services: Health care to prevent illness or detect it at an early stage

As long as you have worked for at least 10 years in your lifetime in the United States, you likely won’t have a premium for Part A. 

Part B has a premium of $144.60 for most people. If you had an income above $87,000 ($147,000 for joint tax returns) in your applicable tax year you will pay more.

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Medicare Advantage (Part C)

Medicare Advantage is a Medicare insurance plan that supplies your Part A and B coverage while providing additional benefits.

Each plan has an out-of-pocket max (something Medicare doesn’t have) and may provide: 

  • Adult day-care services
  • Dental
  • Vision
  • Hearing
  • Fitness club memberships
  • Prescription drug coverage
  • Services and supports for those with chronic conditions
  • Transportation to doctor visits

What benefits you are offered will depend on where you live.

Medicare Part D

Original Medicare does not have any prescription drug coverage. So, Part D steps in to plug that gap. 

There’s only two ways to get Medicare Part D: through a standalone plan or as a part of a Medicare Advantage plan. 

Each prescription drug plan includes at least two drugs in the most commonly prescribed categories and classes. Also, all plans generally must cover at least two drugs per category, but plans can choose which ones covered by Part D they will offer.

Medicare Supplements (Medigap plans)

Medicare Supplements take care of your cost-sharing responsibilities surrounding Original Medicare. 

You are responsible for 20% of lots of services and care under Original Medicare. 

Also, if you have a lengthy (or repeat) hospital stay you could receive a hefty bill. 

Part A will cover 100% of your hospital inpatient stay up to 60 days in a benefit period. After that you pay: 

  • Days 61–90: $352 coinsurance per day of each benefit period.
  • Days 91 and beyond: $704 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime).
  • Beyond lifetime reserve days: all costs.

There are 10 lettered plans which each cover a different percentage of: 

  • Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
  • Part B coinsurance or copayment
  • Blood (first 3 pints)
  • Part A hospice care coinsurance or copayment
  • Skilled nursing facility care coinsurance
  • Part A deductible
  • Part B deductible*
  • Part B excess charge  
  • Foreign travel exchange (up to plan limits)

*As of January 1, 2020, Medigap plans sold to new Medicare beneficiaries aren’t allowed to cover the Part B deductible. Because of this, Plans C and F are not available to people new to Medicare starting on January 1, 2020.