What is Medicare Part A?
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Most of the time Part A does not cost a dime.
Original Medicare contains two parts -Part A and Part B. Part A covers inpatient care.
Medicare Part A covers:
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Inpatient hospital care
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Skilled nursing facility care
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Home health care
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Hospice care
What does Medicare Part A cover?
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Inpatient hospital care: This includes all care you receive after being admitted into a hospital by a physician. Medicare covers up to 90 days each benefit period in a general hospital. In addition, you receive 60 lifetime reserve days. It also covers up to 190 lifetime days in a Medicare-certified psychiatric hospital.
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Skilled nursing facility care: Medicare covers your room, board, and certain services provided in a skilled nursing facility. This includes medications, tube feedings, and wound care. It covers up to 100 days each benefit period. To qualify, you must have spent at least three consecutive days in the hospital within 30 days of admission to a skilled nursing facility and must have needed skilled nursing or therapy services.
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Home health care: Though it is normally covered by Part B, Part A coverage will kick in if you have spent at least three consecutive days as a hospital inpatient within 14 days of receiving home care. Up to 100 days of daily care are covered or an unlimited amount of intermittent care.
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Hospice care: Hospice care is covered for as long as your provider certifies it is necessary.
Am I eligible for Medicare Part A?
Most people are eligible at age 65 if they're already collecting retirement benefits form the Social Security Administration or the Railroad Retirement Board. You may also qualify if you have a disability, end-stage renal disease, or amyotrophic lateral sclerosis (Lou Gehrig's Disease). You must be either a United States citizen or a legal permanent resident of at least five continuous years.
Medicare Part A has no cost.
Certain taxes you paid during your working years are specifically for future Medicare coverage.
How much does Medicare Part A cost?
Most of the time, Part A has no cost. Certain taxes you paid during your working years are specifically for future Medicare coverage.
As long as you have worked for at least 10 years in your lifetime in the United States, most of the time you won't pay a dime. If you have not, you can still purchase Part A if you've been a legal resident or have had a green card for at least five years.
Speak with one of our Medicare specialists for the latest premium costs.
What is Medicare Part B?
Medicare Part B is an outpatient medical coverage. Part B helps pay for medically necessary services performed on an outpatient basis that are needed to diagnose and treat a medical condition.
Surgeries, lab work, and preventative services are all covered under Part B.
Medicare Part B covers:
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Provider services
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Durable medical equipment
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Home health services
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Ambulance services
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Preventative services
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X-rays and lab tests
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Certain prescription drugs
What does Medicare Part B cover?
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Provider services: services deemed medically necessary are covered under Part B.
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Durable medical equipment: Equipment that serves a medical purpose, able to withstand repeated use, and appropriate for home use, is covered.
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Home health services: If you are homebound and need skilled nursing or therapy care, you're covered under Part B.
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Ambulance services: Emergency transportation by ambulance. Limited coverage for non-emergency transportation is available in which there is no safe alternative as long as it is medically necessary.
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Preventative services: Outpatient physical, speech, and occupational therapy services are covered as long as they are administered by a Medicare-certified therapist.
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X-rays and lab tests: All doctor ordered x-rays and lab tests are covered.
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Chiropractic care: Only when medically necessary to fix subluxation of the spine.
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Certain prescription drugs: Certain drugs such as immunosuppressants, select anti-cancer, select antiemetic, select dialysis, and other typical drugs administered by a physician.
How much does Medicare Part B cost?
There is a monthly premium. The month premium is decided by the government and determined by your income level.
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Do I have to apply for Medicare Part B?
If you are already receiving Social Security benefits you will automatically be enrolled in Medicare
Part B. Your card will arrive in the mail by the month before your birthday.
If you do not receive Social Security benefits, you have to enroll yourself. You can do it online, or in person at your local Social Security office. Your card will come within three weeks after you apply.
Medicare Part B excess charges
So, what are you on the hook for under Part B?
Beyond your specialized deductible, you will pay 20% of the remaining costs with no limits or cap. You will also pay for any excess charges a provider or facility may charge beyond what Medicare reimburses.
If this sounds out of your budget, don't worry. There are Medicare Supplement plans that are meant to cover the gaps left over by Part B.
What is Medicare Part C?
Medicare Part C is also called Medicare Advantage (MA). It's an alternative benefit form to Original Medicare.
Medicare Advantage may include prescription drug coverage, along with other extra benefits. It is offered through private insurance companies, so you don't enroll in it at the Social Security office or website. You talk with a licensed Medicare agent like the ones at The Integrity Group.
Medicare Part C covers:
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Dental coverage
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Vision coverage
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Caregiver Counseling
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Housekeeping
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Prescription Drug Coverage
What does Medicare Advantage cover?
You are still enrolled in Original Medicare under a Medicare Advantage Plan.
However, MA plans may offer certain benefits that Original Medicare doesn't cover, such as:
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Dental coverage
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Vision coverage
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Caregiver Counseling and Training
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Housekeeping
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Prescription Drug Coverage
What does Medicare Part C cost?
Some Medicare Part C plans have premiums as low as $0. However, this does not mean it is free. Medicare pays a monthly sum to the insurance carrier to provide your care. That's how premiums can be at no-cost to you.
So, be sure to talk to a Part C specialist at The Integrity Group to see what you can qualify for!
Medicare Part C enrollment periods
You can enroll in a Medicare Advantage plan when you first get Medicare Part B. You can also do so during the annual election period each fall, which is from October 15 to December 7. Your benefits begin January 1.
As long as you are enrolled in BOTH
Medicare Part A and B you can
purchase a Medicare Advantage plan.
Am I eligible for Medicare Part C?
Any Medicare beneficiary is eligible for Part C.
As long as you are enrolled in Both Medicare Part A and B you can purchase a Medicare Advantage plan. You cannot drop Part B. If you do so, you will lose Part C coverage.
What will I pay out-of-pocket for Medicare Advantage?
Every Medicare Part C plan is required to have an out-of-pocket maximum. This amount is decided by Medicare each year. Currently, this number is $6,700.
However, each plan differs and you'll find many plans that set a lower maximum.
This is a great value because Original Medicare has no out-of-pocket maximum. You are required to pay 20% of your services over and over.
What is Medicare Part D?
Medicare Part D is the prescription drug benefit offered through insurance companies as either a stand-alone plan or beneficiaries can choose a Medicare Advantage plan that also features prescription drug coverage.
Medicare Part D covers:
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HIV/AIDS treatment
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Antidepressants
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Antipsychotic medications
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Anticonvulsive treatments
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Immunosuppressants
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Anticancer drugs
What does Medicare Part D cover?
Each Part D plan has a list of covered drugs called a formulary. If the drug you need is not on the formulary, you are allowed to request an exception, pay out of pocket, or file an appeal.
These formularies differ from plan to plan so be sure to request a copy. However, each plan must cover all drugs in the following categories:
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HIV/AIDS treatment
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Antidepressants
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Antipsychotic medications
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Anticonvulsive treatments for seizure disorders
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Immunosuppressants
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Anticancer drugs (unless they are being covered under Part B)
Most vaccines are also covered under Part D unless they are already covered under Part B.
How much does Part D cost?
Monthly premiums and copay differ from plan to plan.
However, as discussed earlier, each plan has a formulary that lists different drugs that are covered. So, the cheapest plan may not always be the best choice. Be sure to speak with a licensed Medicare agent that double checks the plan you are interested in will cover all of your drugs.
How do I enroll in prescription drug coverage?
You can only enroll in a Medicare Part D plan in the service area in which you live. So, you can do so through an insurance provider that is licensed in Medicare services. You can also enroll in Medicare Part D through Medicare's website.
Some Medicare Advantage plans also include Part D coverage. Again, if this is how you would like to receive your prescription drug coverage, make sure it covers all the drugs you require.
Some Medicare Advantage plans
also include Part D coverage.
Enrollment periods
You can enroll in Medicare Part D when you enroll in Original Medicare.
This is the three months before you turn 65 and the three months after your 65th birthday.
There is also an annual election period from October 15 through December 7 in which you can enroll or disenroll from any drug plan.
The insurance company with which you have your plans will mail you an Annual Notice of Change each September. This letter will detail all changes coming with your plan so you can decide if you would like to make a change.
If you wish to keep your current coverage, you don't have to do a thing. It will automatically renew in January.