Parts of Medicare are the different segments of Medicare, and they include Parts A, B, C, and D. Each part is a separate program, but they all work together to provide health insurance for those who qualify. Each part has its own eligibility requirements and costs.
Medicare Parts A and B combined are also called Original Medicare or Traditional Medicare, a federal health insurance program for those age 65 and older, as well as those under 65 and permanently disabled. Below we discuss the Medicare benefits Original Medicare covers and more.
Introduction to Medicare
Medicare is a federal health insurance program that provides coverage to individuals 65 or older, as well as certain younger people with disabilities. The program is divided into four parts: A, B, C, and D, each offering different types of coverage. Understanding the different parts of Medicare is essential for making informed healthcare decisions. Medicare Part A, also known as hospital insurance, covers hospital stays, skilled nursing care, and hospice care. Medicare Part B, or medical insurance, covers doctor visits, outpatient services, and medical equipment. Medicare Part C, also known as Medicare Advantage, offers an alternative to Original Medicare and often includes additional benefits such as prescription drug coverage. Medicare Part D provides prescription drug coverage and can be purchased separately or as part of a Medicare Advantage plan.
Medicare Part A
Medicare Part A is the first half of Original Medicare. It is also referred to as hospital coverage, it covers hospital care, including inpatient services and covers hospice care.
Medicare Part A also includes hospital coverage for services such as inpatient hospital stays, rehabilitation care, and other essential medical services.
Inpatient Hospital Stays
Medicare Part A covers inpatient care. This includes Part A hospital insurance, which covers general nursing, meals, prescription drugs, and any supplies and medical services that are prescribed as an inpatient. It also covers any pre-op tests that could be required prior to inpatient surgery.
In addition, Part A covers inpatient mental health services.
Services Medicare Part A doesn’t cover when it comes to hospital stays include:
Private rooms
Care from a private duty nurse
Personal items like toothpaste, razors, and shampoo
Skilled Nursing Facility Care
Skilled nursing facility care is when you are placed in a nursing facility after being discharged from the hospital. It is also known as post-acute care, and it is covered under Medicare Part A. In order to be covered, you must have spent at least three midnights as an inpatient.
However, your plan may have limitations on the amount of time you can stay in a skilled nursing facility and what types of care are covered. Skilled nursing care provides rehabilitation services for patients who have suffered a serious injury or illness and need help with daily activities like walking and bathing while recovering.
The services Medicare Part A covers include:
Physical, occupational, and speech therapy
Medical equipment and supplies
Care from a skilled nurse
Medications
Ambulance transportation
Semi-private room
Meals
Medicare Part A covers these services for a period of time, which is called the “benefit period, ” which in this case is up to 100 days. The benefit period begins on the first day of care and ends on the 100th day.
Keep in mind, Medicare is not long-term care. You can find the details Medicare Part A and B benefits here in our Resources page.
Home Health Services
Medicare Part A and Medicare Part B cover home health services only if you are homebound or have a medical condition that makes it impossible for you to leave your house.
This includes services such as medical supplies and equipment, physical therapy and occupational therapy, Speech-language pathology services, and medical social services.
Services it doesn’t cover include the provision of meals, 24-hour care, housekeeping, and personal care services.
Hospice Care
Hospice care is an alternative to hospital and nursing home care. It provides comfort and pain management to patients who have a terminal illness and may be near death.
This type of care can be provided in a patient’s home, a nursing facility, or other location where the patient resides.
Hospice care is covered by Medicare Part A as long as the patient meets certain criteria. These include:
A diagnosis of a terminal illness with six months or less to live
The patient has accepted the diagnosis and decided not to pursue curative treatment and has signed a statement to that effect
The patient has chosen hospice care as an alternative to curative treatment
The hospice care services Medicare Part A covers include:
Nursing care and nursing services in a patient’s home, including medication management
Therapy and grief counseling provided by a licensed social worker or psychologist
Medication management to help with the symptoms of a terminal illness, such as pain and nausea
Medical supplies, such as syringes or bandages, if they are needed for the patient’s comfort and well-being
Occupational, speech, and physical therapy
There are many other services that the plan covers, but they are also some that it does not cover, such as room and board if you are in a nursing home or your own home.
Cost of Medicare Part A
The cost of Medicare Part A will depend on when you enrolled for Medicare. If you are enrolled in Medicare as an under age 65 person on disability, you will not pay a monthly premium for Part A. This is referred to as the “premium-free Part A” option.
If you are starting your Medicare at age 65 or older and you or your spouse has paid Medicare taxes for at least ten years, you won’t pay a premium. Part A was already paid for through payroll Medicare taxes. Most people have paid Medicare taxes (or their spouse) and receive Part A premium free. However, it’s important to note that while Part A may be premium-free, there is an annual deductible that applies to Medicare Part B, which is $240 for 2024. This deductible must be met before insurance starts to pay for doctor visits and outpatient services.
Medicare Part B
Medicare Part B medical insurance is that portion of your Medicare that covers outpatient services and doctor services. It covers doctor visits, including those with a primary care doctor, durable medical equipment, lab tests, drug coverage for prescription medication administered by a health care provider and outpatient surgery. It also covers:
Mental Health
Medicare Part B medical insurance covers outpatient mental health services. It covers any care or services you receive from a psychiatrist or other medical doctor who specializes in the treatment of mental disorders.
These services include:
Psychotherapy
Counseling
Mental health screenings (for example, depression screening)
Psychiatric evaluations
Medical management
Psychiatric medication not self administered
The plan will only cover you when a mental health professional accepts to treat you.
Preventive Services
Medical Part B covers a range of preventive services through what they call Wellness Visits. These include:
Screenings. These are tests that can help identify a disease before symptoms appear, and they include mammograms, Pap smears, cancer screenings, STD screenings, and blood tests for cholesterol levels and diabetes.
Immunizations. Medicare Part B covers vaccines against influenza (flu), hepatitis, and pneumonia.
You can find the full list of preventive services covered under the Medicare Part B plan by going to the Medicare website or viewing the Guide to Medicare’s Preventive Services in our Resources page.
Medically Necessary Services
If a service or treatment is considered “medically necessary” by your doctor, it should be covered under Part B. Part B also covers ambulance services, durable equipment, lab tests, some chiropractic care and medications that are administered by a healthcare professional outside of your home.
One of the reasons that exams for corrective vision are not covered is that vision correction is not considered medically necessary. Diseases and conditions like cataracts, glaucoma or diabetic retinopathy are covered, but vision is not.
Cost of Medicare Part B
The monthly part B premium is set each year by the federal government, based on the Medicare Trustees’ projections of how much it will cost to cover all of the benefits in Part B.
For 2023, the standard monthly premium is people is $164.90. This amount is not fixed and may change yearly. You will also need to pay a deductible each year. In 2023, the Part B deductible is $226. This amount is also not fixed and will vary from year to year.
Medicare Part C
Medicare Part C Medicare Advantage, is a health plan that offers an alternative to the traditional fee-for-service Medicare program. Part C Medicare Advantage replaces your Medicare Part A and Part B. In fact, it was originally called a Medicare replacement policy.
Some argue that it is misleading to call a Medicare Advantage plan a part of Medicare because technically it is not. They are regulated health insurance managed by a private insurance company. The private insurer must stay within certain guidelines, but maintains control of your healthcare. The intent behind creating Medicare Advantage plans was to reduce health care costs. But these plans have proven to be more expensive than Original Medicare due to the additional monthly premium and additional premium that enrollees may need to pay.
Some agents will claim that Medicare Advantage Plans have all the same benefits of Original Medicare Parts A & B. That is misleading. It would be more accurate to say that Medicare Advantage Plans have all the same benefit categories as Part A & B, but not the same benefits. For example, both Medicare Advantage and Original Medicare cover physical therapy, but an Advantage plan will often not cover all the physical therapy your doctor recommends. It is crucial to review your medicare health plan annually to ensure it meets your current health needs.
While Medicare Advantage plans generally cover the services offered under Part A & B, many Medicare Advantage plans also include Part D prescription drug coverage. Reviewing your medicare plan during the open enrollment period can help you adjust your coverage to better suit your needs.
In order to qualify for a Medicare Advantage plan you must have Medicare Part A & B. You will also need to continue to pay your Part B monthly premium even though the Advantage plan replaced Part B. Also, it’s important to understand that your out-of-pocket costs can vary from one Advantage Plan to another as will your medical coverage. Medicare Advantage plans are offered by private health insurance companies, which may provide additional benefits not covered by Original Medicare.
Enrolling in a private health plan, such as Medicare Advantage, can offer additional perks and benefits that enhance your overall healthcare coverage. These plans often include services beyond what Original Medicare offers.
Private insurers play a significant role in providing Medicare Advantage plans. They offer both standalone Part D plans and integrated options within Medicare Advantage plans, making it essential for enrollees to compare different plans for the best coverage and costs.
HMOs and PPOs
Most Medicare Part C plans are designed as either an HMO or a PPO. HMO are Health Maintenance Organizations. PPOs are Preferred Provider Organizations.
Both plan designs replace Parts A and B and offer local medical services. Some include extra benefits including dental care.
PPOs will typically cover out of network services if the out of network doctor accepts your plan. An HMO usually only offers benefits through its contracted health care providers. With either plan, only approve covered services are insured. Services not approved by the plan are paid 100% by the Medicare beneficiary.
No Supplement Allowed
When you have Medicare Part C you are not allowed to also have a Medicare supplement. In fact Medicare supplement plans will not offer any benefits if you have an Advantage plan.
Cost of Medicare Part C
Since Medicare Part C (Advantage plans) are offered by private insurance companies, the cost of each plan varies. In general, you can expect to pay between $0 and $200 per month for a Medicare Part C plan.
Some plans have deductibles that you’ll need to pay before your benefits start. Medicare Part C plans are available in all states, and the federal government subsidizes the plan by paying approximately $1,000 or more per month for every person on the plan. Unlike supplemental insurance, which is designed to cover out-of-pocket costs for Medicare Parts A and B, Medicare Part C plans cannot be used in conjunction with supplemental insurance and may have additional premiums.
Medicare Part D
Medicare Part D is a prescription drug plan that helps you pay for your prescriptions drugs. It is not part of Original Medicare but compliments it.
Prescription drug plans are regulated. Every Part D plan must cover a minimum of two prescription drugs from each category of drug, plus cover substantially every prescription drug from six protected categories. Protected categories include immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics. Drug costs differ from plan to plan.
You can enroll in Medicare Part D:
If you’re eligible for Original Medicare
You don’t have another drug plan that covers your prescriptions
If you are enrolled in Part A or Part B of Medicare
You cannot enroll in stand-alone Part D prescription drug coverage if you have a Medicare Advantage Plan HMO or PPO. Even if your HMO or PPO does not include its own Medicare prescription drug coverage.
If you qualify for Medicare but have not yet enrolled, you can sign up for a Medicare drug plan during the open enrollment period, which runs from October 15 to December 7 of each year.
Cost of Medicare Part D
If you enroll in Medicare Part D, you’ll pay a monthly premium. This helps offset the cost of your prescription drugs.
If you have limited income, you may be eligible for Extra Help. This program covers all or most of your premiums and cost-sharing. You can apply for Extra Help by completing a Medicare application and submitting it to Social Security.
Medicare Coverage
Medicare coverage includes a wide range of services, such as hospital stays, doctor visits, outpatient services, and medical equipment. Original Medicare, which includes Parts A and B, covers most healthcare costs, but there may be out-of-pocket costs, such as deductibles, copayments, and coinsurance. Medicare Advantage plans, on the other hand, often include additional benefits, such as vision, dental, and hearing coverage, and may have different cost-sharing structures. It’s essential to review Medicare coverage options carefully to ensure that you have the right coverage for your healthcare needs. Medicare Part A covers inpatient hospital stays, while Medicare Part B covers outpatient services, including doctor visits and lab tests. Medicare Part D provides coverage for prescription drugs, which can be purchased separately or as part of a Medicare Advantage plan.
Understanding Out of Pocket Costs
Out-of-pocket costs can add up quickly, even with Medicare coverage. It’s essential to understand the different types of out-of-pocket costs, such as deductibles, copayments, and coinsurance. Medicare Part A, for example, has a deductible for hospital stays, while Medicare Part B has a deductible for doctor visits and outpatient services. Medicare Advantage plans may have different out-of-pocket costs, such as copayments for doctor visits or coinsurance for hospital stays. Prescription drug plans, including Medicare Part D, may also have out-of-pocket costs, such as copayments or coinsurance for prescription medications. To minimize out-of-pocket costs, it’s crucial to review Medicare coverage options carefully and choose a plan that fits your healthcare needs and budget.
How To Save on Medicare Parts
Shop for the Best Deal
You’ll have several options when it comes to purchasing Medicare Parts, including private insurance companies and government-sponsored plans like Medicare Advantage or Part D. Check out each option’s coverage and pricing before you buy.
You can also compare prices by getting quotes from several insurers. You may be able to save money by choosing a plan with a lower premium but higher deductible and co-insurance. If so, you’ll pay less out-of-pocket over time.
Use Your Plan’s Cost-Sharing Feature
Many Medicare plans offer cost-sharing features that help you pay for certain services or medications. You may be able to lower your costs by using these features instead of paying the full price yourself. For example, some plans offer a lower deductible for certain services if you use providers in the plan’s network.
You can ask the provider about these features when you’re choosing coverage and getting quotes.
Enroll Early
If you enroll early for a Medicare part, you might not need to pay a premium. For example, if you enroll early for Medicare Part A, you may be eligible for premium-free coverage.
Those who enroll late will need to pay a premium, and for some Medicare parts, you can even be penalized.
Enroll in a Medicare Advantage Plan
If you have Medicare Part A and B, you may be eligible for a Medicare Advantage Plan. This plan offers additional benefits that Medicare doesn’t, such as vision and dental coverage.
Additionally, these plans are offered by private insurance companies, which means you can compare plans based on coverage, cost, and other factors.
This can help you decide which plan is best for you based on your needs and budget. Also, most Medicare Advantage plans have low monthly premiums, so you won’t need to pay much out of pocket.
Get a Medicare Supplement Insurance Plan
If you’re on Medicare, you may be eligible for a Medicare Supplement Insurance Plan, also known as a Medigap plan. This plan provides coverage for the gaps in your original Medicare coverage, such as deductibles and co-pays.
It’s a good idea to have Medicare supplement plans if you plan on going out of network or have frequent medical issues. The plan covers services such as durable medical equipment, home health care, and even foreign travel.
You can purchase a Medicare Supplement Plan through an independent Medicare broker like Medigap Seminars Insurance Agency. We offer all Medicare supplement plans in every state.
Get Help From the Government
If you have limited income, you may be eligible for government assistance. The government offers a number of programs that help pay for medical expenses, including Medicaid and Extra Help.
Medigap Seminars Insurance Agency Reviews.
Choosing the Right Medicare Options
Choosing the right Medicare options can be overwhelming, but it’s essential to ensure that you have the right coverage for your healthcare needs. Original Medicare, which includes Parts A and B, provides basic coverage, but you may want to consider additional coverage, such as a Medicare Advantage plan or a Medicare Supplement plan. Medicare Advantage plans offer an alternative to Original Medicare and often include additional benefits, such as prescription drug coverage, vision, and dental coverage. Medicare Supplement plans, on the other hand, provide additional coverage for out-of-pocket costs, such as deductibles, copayments, and coinsurance. To choose the right Medicare options, consider your healthcare needs, budget, and lifestyle. You may want to consult with a licensed insurance agent or broker to help you navigate the different Medicare options and choose the best plan for you.
Wrapping Up
Medicare is not complicated once you understand the parts of Medicare and the role each part plays in your Medicare coverage. Parts of Medicare coverage are a foundation of your healthcare once age 65.
