Medicare Basics

The A, B, C’s (and D’s) of Medicare

What is Medicare?

Established in 1965, Medicare is a federally funded health insurance program for people age 65 or older; or people younger than 65 who have certain disabilities; or people of any age with End Stage Renal Disease (ESRD).

THE ABC & D’s of Medicare

Let’s review what each piece of your medicare coverage does.

Medicare Part A covers

Hospital and skilled nursing facility stays, hospice care at a facility or at home, and home health care.

Some examples of when you would use Medicare Part A:

You would use Medicare Part A if you have rehab from surgery, if you have medical conditions that require regular at-home nurse care, such as a wound that is healing or, to provide comfort care at the end of life in the form of hospice care.

Home Health Care Medicare Part A

Medicare Part A is provided by the Federal Government.

There is a deductible – which is the amount you are responsible for paying before the Medicare coverage starts to cover your costs.

There are co-pays for services rendered.

Most people do NOT pay an annual premium for Medicare Part A.

Medicare Part B covers

Outpatient care such, doctor services, physical and occupational therapy, behavioral health services, preventive care.

Some examples of when you would use Medicare Part B

Your Medicare Part B insurance pays for visits to the doctor to deal with early flu symptoms, when you see a psychiatrist because of signs of depression, when you need a wheelchair after surgery, the caregivers who do physical therapy to regain strength are covered by Medicare Part B as well as medications you may need following a surgery but not ongoing.

Medicare Part B Doctor Visits

Medicare Part B is provided by the Federal Government.

There is a deductible – which is the amount you are responsible for paying before the Medicare coverage starts to cover your costs – but not for preventative services like seeing the doctor when you feel sick.

There are co-pays for services rendered that are often 20% or more of the cost of the services you receive.

The annual premiums for Medicare Part B are adjusted based on your annual gross income.

Medicare Part D covers

Your prescription drugs.

Medicare Part D is provided by private insurance plans that are approved by Medicare.

Checking Prescriptions

There is a deductible – which is the amount you are responsible for paying before the Medicare coverage starts to cover your costs.

There are co-pays and some plans have a $0 co-pay.  Part D is most often provided with Medicare Advantage (Plan C).

Medigap is also known as Medicare supplemental insurance.

The purpose of Medigap is to fill the gaps left by Medicare Plan A & B leave. Unlike Medicare Part A and B, Medigap is private insurance that works with your Medicare coverage.
There are 10 Medicare supplement insurance plans, labeled “A” through “N.” not to be confused with the Medicare Part A, B, C, and D plans.  Each of the Medigap plans and what they cover are regulated by the federal government.

Therapy Dog Visit

Each Medigap A – N plan provides the same benefits, no matter which insurance company sells it, the difference in the cost is based on the carrier who provides the coverage.  Your costs are not higher by using a broker, your costs are determined by the insurance carrier providing the policy.

Medicare Part A Costs

What Will You Pay for Part A?

Part A Premium

If you or your spouse worked for more than 10 years, you paid Medicare taxes, and therefore, you don't pay an annual premium for Medicare Part A. However, you may be able to buy Part A if you are not eligible through your work history.

Part A Hospital Inpatient Deductible

When you have traditional Medicare Part A, as opposed to Medicare Advantage or Medigap, there is a deductible for each benefit period.

Other Medicare Part A Costs

When you have traditional Medicare Part A, as opposed to Medicare Advantage or Medigap, You pay:

  • $0 Home Health Services
  • $0 Hospice
  • Coinsurance per day beginning on day 61 for inpatient hospitalization
  • Coinsurance per day beginning on day 21 for skilled nursing facility stays

Medicare Part B Costs

What Will You Pay for Part B?

Part B Premium

Most people pay a standard premium each month. If your adjusted gross income is above a certain amount, you will pay more. You also could pay a late enrollment penalty if you delayed your enrollment.

 

Part B Deductible

There is a deductible for each benefit period.

 

Other Medicare Part B Costs

There is no copay for Medicare-covered preventive services. You typically pay 20% for most Medicare-approved doctor services, outpatient therapy, and durable medical equipment.

 

The support you need to get enrolled in the right Medicare Program for you.

We can help find the right program for you to cover your health expenses while being sensitive to your budget and healthcare needs today and into the future.

The best part? We don't charge you anything.
Insurance carriers cover our costs so we can offer you the guidance you need totally free.

[wpforms id="1039"]