What Does Medicare Cover And How Does It Work?
It’s important to understand how Medicare coverage works to get the most out of your plan. Medicare isn’t a single type of health coverage. Instead, it has four distinct parts: Medicare Part A, Part B, Part C, and Part D. Also, there are Medicare Supplement insurance plans if you need additional coverage to reduce your out-of-pocket expenses. Choosing the right type of Medicare is a big decision because medical costs can dramatically impact your finances. Here’s what you need to know about Medicare to select the right plan based on your healthcare needs.
What Is Medicare Part A?
Medicare Part A—also referred to as hospital insurance—is Original Medicare, and it covers expenses incurred from hospital stays and other hospital services. This includes inpatient and outpatient hospital care, such as emergency room visits, surgeries, lab tests, X-rays, etc. Medicare Part A also covers the cost of staying in a skilled nursing facility, hospice care, and the use of walkers and wheelchairs. Many adults are automatically enrolled in Medicare Part A at age 65. As far as what they pay on a monthly basis, people who receive Social Security benefits don’t pay a monthly premium for Part A. They do, however, pay a premium if they’ve yet to receive Social Security benefits, most likely because they’re still working. Keep in mind you are responsible for paying your Part A deductible each year, which is your out-of-pocket expense before Medicare pays your hospital expenses. You might also be responsible forcopayments and coinsurance.
What Is Medicare Part B?
Medicare Part B—which also falls under Original Medicare—is medical insurance. Part B covers doctor visits, tests, preventative care, medical supplies, screenings, and medical equipment. Other coverage benefits of Medicare Part B also includes physical therapy, occupational therapy, speech and language pathology, and mental health services. In most cases, you’re automatically enrolled in Part B once you turn 65, too. But while most people don’t pay a monthly premium for Part A insurance, many people do pay a monthly premium for Medicare Part B, which is determined by their income. Other Part B out-of-pocket expenses include deductibles, copayments, and coinsurance.
What Is Medicare Part C?
For some older adults, Original Medicare (Part A and Part B) is sufficient. Original Medicare, however, doesn’t cover every medical expense. It only provides basic coverage, so depending on your healthcare needs, you might need a health plan that offers more. If so, you should look into purchasing Medicare Part C, also known as Medicare Advantage. This is different from Original Medicare in that Medicare Part C is only offered through private insurance companies. Under this coverage, you’ll receive the benefits of Medicare Part A and Part B. In addition, some Medicare Advantage plans include prescription drug coverage (Medicare Part D). Other health benefits of Medicare Part C include:
VisionHearingDental Non-emergency transportationHome meal deliveryFree fitness membership (SilverSneakers)
If you sign up for a Medicare Advantage plan, you’ll pay a monthly premium. Be mindful that with some Medicare Advantage plans you’re limited to doctors and hospitals within the plan’s network. You’ll also need a referral before seeing a specialist. This is different from Original Medicare, where you can see any doctor or hospital in the U.S. that accepts Medicare and where you don’t need a referral to see a specialist.
What Is Medicare Supplement Insurance?
Because Original Medicare Part A and Part B don’t cover everything, you might benefit from enrolling in a Medicare Supplement insurance plan. This plan is only available with Original Medicare, so it’s not available with Medicare Advantage Part C. This supplement insurance plan is designed to cover some of the out-of-pocket costs that aren’t covered by Original Medicare. This can include all, or a percentage of your deductibles, copayments, and coinsurance. Medicare Supplement insurance is recommended if you anticipate gaps in coverage or if you need assistance with excess charges. These plans pay up to 100% of coinsurance and copayments for doctor visits, hospital stays, hospice care, skilled nursing care, and more. Some supplement plans cover a portion of emergency medical care expenses you receive outside the U.S. There are different Medicare Supplement insurance plans, so carefully review your options and choose a plan that best meets your needs. Medicare Supplement insurance plans vary by state.
What Is Medicare Part D?
If you enroll in a Medicare Advantage plan, you have the option of plans that include Medicare Part D prescription drug coverage. You can, however, also purchase Medicare Part D as a standalone policy if you’re enrolled in Original Medicare. This plan helps cover the cost of prescription and brand name medications, although you are responsible for monthly premiums, annual deductibles, copayments, and coinsurances.
Medicare Open Enrollment
Medicare gives many older adults access to healthcare, but these plans aren’t one-size-fits-all. It’s important to do your research and select a plan that fits your needs. Medicare open enrollment is each year from October 15 through December 7. During open enrollment, you can sign up for a Medicare Advantage plan, Medicare Part D, or Medicare Supplement insurance. You can also switch from Original Medicare to a Medicare Advantage plan at this time, and vice versa. Or, switch from one Medicare Advantage plan to another, or from one supplement insurance or Part D plan to another one. Understanding the different options first is the best way to make sure you choose the right coverage for you. Each Medicare plan and insurance product we feature has been independently selected and reviewed by the Medicare Expert USA team. If you make a purchase using the links included, Parade.com may be compensated. Next up, here’show to be a good caregiver and take good care of yourself, too.
