What is Medicare?

Medicare is the federal health insurance program for people who are 65 or older or those younger than 65 with certain disabilities.

Most people who qualify have Part A and Part B which helps cover the cost of Hospitalization and Doctor visits respectively.

However, some people need to get additional coverage, like Medicare Advantage, prescription drug coverage, or a Medicare Supplement  (Medigap).

What is Medicare Part A?

 

Part A (Hospital Insurance) 

Helps  cover: 

  • Inpatient  care  in  hospitals 
  • Skilled  nursing  facility  care 
  • Hospice  care 
  • Home health care

Most of the time you won’t be charged a premium because of taxes you paid while working. However, if you haven’t worked for at least 10 years in the US you may have to pay a monthly premium.

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What is Medicare Part B?

Part B (Medical Insurance)

Helps  cover: 

  • Services from doctors and other health care providers
  • Outpatient  care 
  • Home health care 
  • Durable medical equipment (like wheelchairs, walkers, hospital  beds,  and  other  equipment)
  • Many  preventive  services  (like  screenings,  shots  or  vaccines, and yearly “Wellness” visits) 

Part B has a premium of $170.10 in 2022 for most people. If you had an income above $88,000 ($176,000 for joint tax returns) in your applicable tax year you will pay more.

What is Medicare Part C (Medicare Advantage)?

Part C is a Medicare insurance plan that takes over for your Part A and B coverage while providing you with additional benefits.

Each plan comes with an out-of-pocket max (Original Medicare doesn’t have that benefit) 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 your plans offer will depend on where you live.

What are Medigap (Medicare Supplement) plans?

With Original Medicare, you will have coinsurance and copays for which you are responsible.

There are 10 lettered Medigap 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.

With these plans, Original Medicare will be billed for your Medicare-related healthcare services. Once it pays its portion, the bill is then sent to your Medicare Supplement provider. Your Medigap provider will pay according to the plan you selected. Anything left over will then be sent to you.

What is Medicare Part D?

 Part D is a private insurance plan that covers a portion of the cost of your prescription medications. 

This is important because Original Medicare does not have any prescription drug coverage.

You can get Medicare Part D through a standalone plan or as a part of a Medicare Advantage plan.