Facts About Medicare
Do you know the difference between the “parts” of Medicare — Part A, Part B, Part C, and Part D? There are many important facts you need to understand about Medicare prior to enrolling to make sure you get the most out the available Medicare plans and benefits.
Background on Medicare
Medicare is a federal health insurance program that pays for a variety of health care expenses. It’s administered by the Centers for Medicare & Medicaid Services (CMS), a division of the U.S. Department of Health & Human Services (HHS). Medicare beneficiaries are typically senior citizens aged 65 and older. Adults with certain approved medical conditions (such as Lou Gehrig’s disease) or qualifying permanent disabilities may also be eligible for Medicare benefits.
Similar to Social Security, Medicare is an entitlement program. Most U.S. citizens earn the right to enroll in Medicare by working and paying their taxes for a minimum required period. Even if you didn’t work long enough to be entitled to Medicare benefits, you may still be eligible to enroll, but you might have to pay more.
There are four different parts to the Medicare program. Parts A and B are often referred to as Original Medicare. Medicare Part C, or Medicare Advantage, is private health insurance, while Medicare Part D offers coverage for prescription drugs. The details below tell you more about Medicare insurance plans, with an overview of the four parts.
The “parts” of Medicare
The types of Medicare programs are often referred to as Part A, Part B, Part C, and Part D. Here’s a rundown of what each “Part” is about.
Medicare Part A
Medicare Part A is hospital insurance. Part A covers inpatient hospital care, limited time in a skilled nursing care facility, limited home health care services, and hospice care.
Most Medicare Part A beneficiaries don’t have to pay a monthly premium to receive coverage under this part of Original Medicare; this is called “premium-free Part A.” Generally, if you’ve worked at least 10 years (40 quarters) and paid Medicare taxes while you worked, you’re eligible for premium-free Part A. Otherwise, you pay a monthly premium.
Medicare Part A typically doesn’t cover the full amount of your hospital bill, so you will probably be responsible for a share in the cost. You will also have to pay a deductible before Medicare benefits begin. Medicare will then pay 100% of your costs for up to 60 days in a hospital or up to 20 days in a skilled nursing facility. After that, you pay a flat amount up to the maximum number of covered days. Your Medicare Part A benefits cover some of the costs for a total of 90 days in a hospital and 100 days in a skilled nursing facility. Medicare also covers up to 60 “lifetime reserve days.” These are days you stay in a hospital longer than 90 days in a row. You get a lifetime total of 60 reserve days.
Medicare Part B
Medicare Part B is medical insurance. Part B benefits cover certain non-hospital medical expenses like doctors’ office visits, blood tests, X-rays, diabetic screenings and supplies, and outpatient hospital care. You pay a monthly premium for this part of Original Medicare. The fee can be higher for people with high incomes. A different government program, Medicaid, can help cover Medicare Part B premiums for low-income beneficiaries.
Medicare Part B beneficiaries are usually responsible for a portion of their health care costs. You’ll have to pay a deductible each year before your Medicare Part B benefits kick in, and then you’ll generally pay 20% of the bill when you go to a participating Medicare doctor. Medicare pays the full cost of many lab tests and services requested by your doctor.
Medicare Part C
Medicare Part C, or Medicare Advantage, insurance often includes every type of Medicare coverage in one health plan. It’s offered by private insurance companies contracted through CMS to provide a Medicare benefits package as an alternative to Original Medicare. Enrolling into a Medicare Advantage plan is optional, but to obtain this private insurance, you must also have Original Medicare, Part A and Part B. You also may have to continue to pay your Part B premium if you have a Medicare Advantage plan.
While Medicare Advantage plans are required to provide all Medicare Part A and Medicare Part B benefits (except hospice care), plans can also include different additional benefits, which vary among the individual private health insurers. Many Medicare Advantage plans include prescription drug coverage known as Medicare Advantage Prescription Drug plans. Some plans might have a lower deductible, while also allowing you to pay a smaller share of the remaining costs. Medicare Advantage plans may even cover certain health care services that Original Medicare, Part A and Part B, does not cover, like eye exams, hearing aids, dental care, or health care received while traveling outside the United States.
Medicare Part D
Medicare Part D is optional prescription drug coverage. Medicare Part D is available as a stand-alone prescription drug plan through private insurance companies, and the monthly fee varies among insurers. You will share in the costs of your prescription drugs according to the specific plan in which you’re enrolled. Those costs can include a deductible, a flat copayment amount, or a percentage of the full drug cost (called “coinsurance”).
If you want prescription drug coverage, you can get it through a Medicare Advantage Prescription Drug plan if there’s one in your area that offers this coverage. You can use the simple form on this page and enter your zip code to view a list of Medicare Advantage Prescription Drug plans in your area.
If you have limited income and cannot afford your medications even though you receive Medicare Part D benefits, you may qualify for the Extra Help program, which offers financial assistance for your monthly premium, deductible, copayment, or coinsurance.