The basics or fundamentals of Medicare has to do with the federal health insurance program established in 1965, providing healthcare coverage to people aged 65 and older, certain younger people with disabilities.
The Medicare category is broadly divided into four parts: Part A, Part B, Part C, and Part D. All these parts and how they work together will be comprehensively explained in this article.
Medicare Part A: Hospital Insurance
Medicare Part A is popularly referred to as hospital insurance. It covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
In most cases, people don’t have to pay a monthly premium for Part A. This is referred to as “premium-free Part A” and is available to individuals who paid Medicare taxes for at least 40 quarters (10 years) while working.
However, those who don’t qualify for premium-free Part A can purchase it by paying a monthly premium. The deductible and coinsurance amounts for Part A vary annually.
In order to be eligible for Medicare Part A, a person must be a U.S. citizen or legal resident having lived in the U.S. for at least five continuous years and be 65 or older.
People under 65 can also qualify for Part A if they have a disability and have been receiving Social Security or certain disability benefits from the Railroad Retirement Board for at least 24 months.
Medicare Part B: Medical Insurance
Medicare Part B is generally referred to as medical insurance. It covers two types of services – medically necessary services that are needed to diagnose or treat a medical condition, and preventive services, which aim to prevent illnesses or detect them at an early stage.
Medicare Part B covers services and supplies like doctor’s visits, outpatient care, durable medical equipment, and preventive services. Unlike Part A, most people pay a monthly premium for Part B.
The premium amount can vary based on income. Moreover, there’s usually a deductible for Part B, after which you typically pay 20% of the Medicare-approved amount for most doctor services.
Part C: Medicare Advantage Plans
Medicare Part C, or Medicare Advantage, is an alternative way to receive your Medicare benefits.
It’s offered by private insurance companies approved by Medicare. Part C plans combine Part A and Part B benefits and often include Part D (prescription drug) coverage. They may also offer additional benefits not covered by Original Medicare, like vision, dental, hearing, or wellness programs.
The costs of Medicare Advantage Plans vary based on the specific plan. These plans usually have a monthly premium in addition to the Part B premium, and there may be additional deductibles and co-pays.
It is important to note that it has a maximum limit on out-of-pocket costs, unlike Original Medicare.
Medicare Part D: Prescription Drug Coverage
Medicare Part D is mainly prescription drug coverage. Like Part C, Part D plans are offered by private insurance companies approved by Medicare. These plans help cover the cost of prescription medications and can protect against higher costs in the future.
The costs associated with Part D plans vary. Most require a monthly premium in addition to the Part B premium. There can also be a yearly deductible, copayments, and a coverage gap, also known as the “donut hole.”
This gap begins after you and your drug plan have spent a certain amount on covered drugs and continues until your out-of-pocket costs reach a yearly limit.
Understanding Medicare is critical for seniors and others eligible for these benefits. Each part of Medicare—Part A, B, C, and D—covers different aspects of healthcare, and it is important to enroll in which plan is ideal for.
Always carefully review the terms of any health insurance plan before making a decision. If you are in doubt, seek advice from a trusted healthcare professional – MedicareOnVideo.
At MedicareOnVideo, we are an independent broker providing authoritative guidance to intending Medicare enrollees at no cost.
In order to learn more, watch our video titled – “How Medicare Basics – Parts of Medicare Explained.”
You can contact us directly via 1-877-855-3484, as well as secure our free ebook on Medicare titled “Medicare Made CLEAR,” which is embedded with up-to-date information on all areas of Medicare coverage.