Millions of Americans are on Medicare, yet there is no denying the fact that it can be a bit confusing. We know that Medicare is the federal health insurance for Americans age 65 years and older, as well as some others with certain disabilities or conditions. However, there is a lot more to the program that most people realize. Here, we will go over exactly what Medicare covers for parts A, B, C, and D.
What is Medicare Part A and What Does it Cover?
Simply put, Medicare Part A refers to hospital coverage. It will pay some costs associated with impatient hospital care after you are admitted by a physician. Medicare also covers skilled nursing facility care and home health care. Lastly, Part A provides hospice care for those who have been told by a physician that they are terminally ill. Most people do not pay for Medicare Part A as long as they or a spouse have 40 or more quarters of Medicare-covered employment. Those with fewer quarters will have to pay a monthly premium.
What is Medicare Part B?
Part B is medical insurance. It provides assistance with covering medically necessary and preventive services such as provider services received from a licensed health professional, clinical research, ambulance services, durable medical equipment, and mental health services. Part B also provides coverage for certain prescription drugs such as immunosuppressant drugs, some anticancer drugs and some dialysis drugs. Therapy services including outpatient physical, speech, and occupational therapy services are covered by Part B as well.
There is a monthly premium for those who enroll in Part B coverage. In 2023, the amount is $164.90 per month. It is important to know that the premium amount is higher for those with yearly incomes of $97,000 or more, and married couples who have income of $194,000 or more.
Parts A & B are referred to as Original Medicare. Those receiving benefits are able to see any doctor in the United States that takes Medicare, and in most cases a referral is not needed to see a specialist.
What is Medicare Part C and What Does it Cover?
Part C of Medicare refers to Medicare Advantage Plans. Beneficiaries can choose to get their coverage through a Medicare Advantage Plan rather than Original Medicare, and coverage is offered through private insurance companies. The plans offer at least the same as Parts A & B, as well as some additional benefits, however there are different rules, costs, and coverage restrictions. Most with Part C also get Part D included in their coverage.
What additional benefits do beneficiaries receive? Typically, vision, hearing, dental, and/or health and wellness programs are included. Each plan can different out of pocket costs, and beneficiaries must remember that specific rules will apply. Referrals may be needed in certain cases, and you must go to hospitals and doctors that accept the plan. In addition to the Part B premium, a monthly premium is charged to those who choose to enroll in Medicare Part C.
What is Medicare Part D and What Does it Cover?
Part D is the prescription drug benefit that covers the most outpatient prescription drugs. Each individual plan is provided through private insurance companies and enrollment in these plans is optional.
All plans are cover a wide range of prescription drugs commonly taken by those receiving Medicare benefits, with each plan’s list of covered drugs called a formulary. A formulary can vary from company to company, and drugs are placed into different levels known as “tiers”, with each tier having different costs.
Typically each plan will offer both brand name and generic choices. It is required that each formulary includes at least 2 drugs in the most commonly prescribed categories and classes in order to ensure that a wide range of drugs are available to those with different conditions.
Should You Get a Medicare Supplement Plan?
Everyone should know that there are supplemental plans that are available to help with any costs that are not covered. A Medicare Supplemental Insurance, also known as Medigap, may help those with Original Medicare pay out of pocket costs such as your 20% coinsurance. However, those with Medicare Advantage are not eligible for Medigap.
The Medigap plans are sold by private insurance companies and may cover outstanding deductibles, and copayments, and are also helpful when a beneficiary is traveling abroad. Depending on location, there are different supplemental plans to choose from, and each one offers different benefits. Keep in mind that premiums can vary from plan to plan, so review each option accordingly. Supplemental Medigap plans for those with Original Medicare are optional, so each individual can decide if they’d like to purchase one based upon their own needs and circumstances.