A Basic Guide to Medicare
Explaining Parts A, B, C, and D in 3-Minutes
Medicare has been the backbone of healthcare coverage for Americans 65 and older since 1965. Like everything else, what started out as practical and efficient has grown increasingly complicated over the years. The goal of this guide is to simplify the complexities of Medicare Parts A, B, C, and D and equip you with the knowledge to navigate the system with confidence.
Part A: Hospital Insurance
What Is It?
Medicare Part A is hospital insurance, providing cover for inpatient care in medical facilities. It’s a fundamental component of Medicare, serving as the first line of financial defense against hospital-related expenses.
What’s Covered?
The coverage extends to semi-private rooms, meals, general nursing, medications as part of your inpatient treatment, and other hospital services and supplies. This part of Medicare also covers skilled nursing facility care, provided certain conditions are met, as well as hospice and limited home health care services.
How Much Does It Cost?
While most enrollees won’t pay a premium for Part A, there are out-of-pocket expenses to consider.
What Are The Limitations?
Medicare Part A coverage for hospital stays is generally up to 90 days per benefit period, with a “lifetime reserve” of 60 additional days that can be used once. Skilled nursing facility stays are covered for up to 20 days, with a coinsurance applied from the 21st through the 100th day.
Part B: Medical Insurance
What Is It?
Part B of Medicare is medical insurance, covering two types of services: medically necessary services needed to diagnose or treat medical conditions and preventive services for illness prevention or early detection.
What’s Covered?
It covers doctor visits, outpatient care, some home health care services, durable medical equipment, and many preventive services like screenings, vaccines, and counseling.
How Do I Enroll?
Part B Enrollment windows are crucial. Failing to enroll when you’re first eligible can lead to lifetime penalties and gaps in coverage.
Part C: Medicare Advantage Plans
What Is It?
Medicare Advantage, or Part C, is an alternative way to receive all the benefits of Parts A and B (and often D) through an array of health plan options offered by private insurance companies approved by Medicare.
What Is Included?
These plans often include extra benefits like fitness programs, over-the-counter drugs, and some may offer dental, hearing, and vision coverage. It is worth finding out from a licensed agent the specifics of what your plan covers.
Can I Go To Any Doctor?
Each plan has its own rules and network of providers. The choice between an HMO or PPO can affect how you receive services and how much you pay. HMOs generally offer cheaper coverage while PPO plans offer a larger network of doctors to choose from.
How To Enroll?
The Annual Enrollment Period from October 15th to December 7th is a critical time for those looking to join, switch, or drop Medicare Advantage plans.
Part D: Prescription Drug Plans
What Is It?
Part D adds prescription drug coverage to Original Medicare. Private companies offer these plans; beneficiaries choose one that covers their drug needs and works with their budget.
How Much Does It Cost?
Part D plans vary in cost and coverage. Most have a tiered copayment system, and all must offer at least a standard level of coverage set by Medicare.
How To Choose a Plan?
It’s vital to review your Part D options annually, as formularies—lists of covered drugs—can change. Consider your medications, plan premiums, deductible costs, and whether your pharmacy is in-network when selecting a plan.
Conclusion
No matter how many informative articles you read, Medicare can still be confusing. Keeping up with the frequent changes is a full-time job. We strongly recommend speaking to a professional each Annual Enrollment Period to make sure that you are enrolled in the best plan for your specific needs.
The team at Flatlands Jessup is happy to answer any Medicare questions and concerns that you may have. Please call our team at 252-495-8965 to schedule an in-person appointment.
