An Overview of Medicare Parts: What You Should Know
When people talk about Medicare and the various Medicare parts, most topics come down to two overarching plan options: Original Medicare, and Medicare Advantage. So, what are the parts of Medicare? There are two components of Original Medicare: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).
Original Medicare will cover most medical services. Medicare will cover 80% of your medical expenses after you have met your deductible. Many people close that gap with a supplemental policy and other parts of Medicare that can help expand your coverage:
- Medicare Advantage (Part C) plans: If you’re looking for an all-in-one plan, a Medicare Advantage or Medicare Part C plan may be the best option for you. Coverage through Medicare Advantage plans includes all of Part A and Part B services, plus additional services like wellness services, dental exams, visions exams, and more. These are private insurance plans that replace Part A and Part B. You’ll pay a single premium for this coverage.
- Medicare Supplement, also called Medigap: This Medicare supplement provides healthcare to individuals age 65 or older and people with qualifying disabilities of any age and helps cover out-of-pocket costs not covered by Parts A and B. Medigap plans are standardized plans offered by private insurers and can vary in costs and coverage. You can see any doctor that accepts Medicare.
- Medicare Part D: This standalone Medicare prescription drug coverage helps with the cost of prescription drugs not covered by Original Medicare or a Medicare Supplement plan.
The Medicare program is run by The Centers for Medicare and Medicaid Services (CMS). The program is partially funded by the federal budget, income taxes paid to Social Security and Medicare, and premiums paid by Medicare beneficiaries. Read on to learn more about the various Medicare parts and to understand the different Medicare parts explained.
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The Benefits and Costs of Different Medicare Parts
Costs for Medicare can vary widely depending on the coverage you choose and the amount of healthcare that you need, and that’s one of the big reasons why it’s important to work with a trusted expert like the Health Plus Life team to consider all of your options and make sure you get the right coverage. Medicare’s different parts can be a valuable way of customizing your coverage, so it’s worth getting to know more before making any big decisions.
Think of Medicare Parts A and B as the baseline in a way. This coverage, administered by the government, will pay for the majority of costs related to hospital and medical care.
The option then comes down to what else you need and want in your health insurance. If you’re looking for bonuses like dental and vision coverage or prescription drug coverage, you need to add these to the Original Medicare coverage.
And that’s why Medicare Advantage represents a big advantage for many people. Instead of worrying about a la carte premiums and coverage types, a Medicare Advantage plan from a private company like Health Plus Life that’s approved by the government can roll everything into one plan with one premium. By working with our experts, you can find the best provider and coverage options for your needs, and you’ll know you’re getting exactly what you want.
How to Choose the Right Medicare Part for You
Medicare Parts A and B are the standard, covering the majority of standard costs related to hospital and medical care. But there are plenty of other Medicare parts, as we’ve discussed above, and that’s why it’s a good idea to consult with the experts to make sure your coverage for the next year is going to be just right for you.
For many people with higher prescription drug costs, Medicare Part D can be an efficient way of reducing out-of-pocket costs. Medigap plans are also a common way to avoid getting hit with big bills, though there’s an additional cost with a supplement plan like this as well.
That’s why Medicare Advantage, also known as Medicare Part C, can be an attractive option for many people. Working with a top private health insurance company like Health Plus Life, you can customize your plan and its benefits, choose from different providers, and know your coverage is going to be exactly what you need and want.
Some of the things we’ll consider as we start your Medicare journey are your overall health, any special medical conditions, and your financial situation. Available plans also vary by state so we’ll consider your state of residence.
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Understanding Enrollment in Different Medicare Parts
There are two main periods of time to understand when researching Medicare enrollment.
First up is the seven-month Initial Enrollment Period to sign up for Parts A and B which begins three months before the month you turn 65, includes the month you turn 65, and ends three months after you turn 65. If you miss that window, you can sign up during the General Enrollment Period which runs from January 1 through March 31 each year. However, late enrollment could lead to higher premiums unless you qualify for a Special Enrollment Period.
For people who already have coverage, the crucial period to focus on is the Annual Election Period, which begins each year on October 15 and ends on December 7, with any changes that are made going into effect the following January 1. This is the time when people can make changes to their health coverage, including Medicare Advantage plans, and it’s also the period when it’s possible to switch to another Part D plan if desired.
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Answers to Your Common Questions about Medicare Parts
What are the different Medicare parts to know?
Medicare is a comprehensive federal health insurance program, divided into four Medicare parts, each designed to cover different aspects of healthcare. Part A, often known as hospital insurance, mainly covers inpatient hospital care but also includes care in a skilled nursing facility (not long-term or custodial), hospice care, and some home health care. Part B, or medical insurance, covers two types of medical services — medically necessary services needed to diagnose or treat a medical condition, and preventive services used to prevent illness or detect it at an early stage. Together, Part A and Part B form what is often referred to as Original Medicare.
Medicare Part C, also known as Medicare Advantage, is an all-in-one alternative to Original Medicare. These plans are offered by private insurance companies approved by Medicare and cover all services under Part A and Part B. Most also include prescription drug coverage, and many provide additional benefits like vision, hearing, dental, and even wellness programs. Lastly, Medicare Part D is optional insurance that covers prescription drugs. It can be added to Original Medicare to help people afford necessary medications.
What exactly is covered under Medicare Part A?
Medicare Part A, often recognized as hospital insurance, primarily provides cover for care received in an inpatient setting such as hospitals. This includes semi-private rooms, meals, general nursing, and drugs as part of your inpatient treatment, among other hospital services and supplies. It also covers skilled nursing facility care — but it’s important to note that this isn’t long-term care. If the criteria are met, Part A can cover care in a skilled nursing facility, hospice, or home health care. However, each of these types of care has specific conditions that must be met to receive coverage.
And what does Medicare Part B cover?
Medicare Part B, also known as medical insurance, covers a wide range of outpatient services, including preventive and medically necessary services. This includes doctors’ services (not only from your primary doctor but also from specialists and surgeons), outpatient medical and surgical services and supplies, lab tests, X-rays, mental health care (including outpatient mental health services, partial hospitalization, and screenings), durable medical equipment like wheelchairs or walkers, and certain preventive services like vaccines and screenings for conditions such as diabetes or cancer. The goal of Part B is to provide coverage for the necessary services and supplies needed for the diagnosis or treatment of medical conditions, as well as preventive services to keep certain illnesses from happening or to detect them early.
What is the role of Medicare Part C?
Medicare Part C, more commonly known as Medicare Advantage, is an alternative to Original Medicare. It is offered by private insurance companies that contract with Medicare. These Medicare-approved private companies must provide at least the same benefits as Original Medicare (those covered under Part A and Part B), but they can also offer additional benefits, such as vision care, hearing aids, dental care, and even health wellness programs. Many also include Part D prescription drug coverage. These plans often have a network of doctors and healthcare providers you must use to get care, although the specifics can vary based on the type of plan (like HMO or PPO).
What is covered by Medicare Part D?
Medicare Part D is the section of Medicare that provides coverage for prescription drugs. It’s offered by insurance companies and other private companies approved by Medicare. Medicare Part D coverage is optional and is offered to everyone with Medicare. To get Part D, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan varies in cost and specific drugs covered. These plans share costs with enrollees through premiums, deductibles, copayments, and coinsurance amounts.
How do the different components of Medicare interact with one another?
The different Medicare parts work together to provide comprehensive health coverage. Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance), covers a significant portion of your healthcare costs but not all. To help with costs not covered by Original Medicare, you can choose to add a Part D plan for prescription drug coverage and purchase a supplemental insurance policy known as Medigap. On the other hand, if you opt for a Medicare Advantage Plan (Part C), it combines the coverage of Parts A and B, usually includes Part D, and may offer additional benefits not covered by Original Medicare.
What are the costs associated with the different parts of Medicare?
The costs of Medicare depend significantly on the specific coverage you select. Part A is usually premium-free if you or your spouse paid sufficient Medicare taxes while working. If you buy Part A, you’d pay up to $471 each month in 2021. Part B has a standard premium amount of $148.50 (as of 2021), which could be higher depending on your income. The premiums for Medicare Advantage (Part C) and Prescription Drug (Part D) plans depend on the specific plan you choose, with varying premiums, deductibles, copays, and coinsurance. Costs can also vary depending on the type and frequency of the healthcare services you use, your location, whether your service providers accept Medicare, and many other factors.
Is it possible to switch between different parts of Medicare?
Yes, you do have the flexibility to switch between different parts of Medicare. Medicare provides certain enrollment periods when you can make changes. The Annual Election Period, also known as Open Enrollment, runs from October 15 to December 7 each year. During this period, you can switch from Original Medicare to a Medicare Advantage Plan, switch or drop a Medicare Advantage Plan, join, switch, or drop a Part D plan. There’s also a Medicare Advantage Open Enrollment Period from January 1 to March 31 each year where you can switch Medicare Advantage Plans or switch back to Original Medicare.