If you’re diving into Medicare for the first time, you may be surprised to find that it’s not one type of plan, but four. Each part of Medicare (A, B, C, and D) covers different medical services and has different costs.
Below you’ll find a quick guide that breaks down each piece of Medicare and the essential facts you need to know.
Medicare Part A
Original Medicare, which the federal government administers, includes two parts — Part A and Part B.
Medicare Part A is also called hospital insurance. It covers:
- Home health care.
- Hospice care (under certain medical conditions).
- Hospital inpatient care.
- Nursing home care if it is inpatient care in a skilled nursing facility that’s not long-term care
- Skilled nursing facility care
Most people won’t have to pay a monthly premium for Medicare Part A. However, there are other costs associated with Part A, including:
- A $1,600 annual deductible for inpatient hospital stays.
- A $400 per day coinsurance for hospital stays between 61 and 90 days.
- A $800 per day coinsurance for each “lifetime reserve day” after day 90 in the hospital. After you reach the 60-day limit of lifetime reserve days, Part A will not cover any hospital costs
- A 20% copay for durable medical equipment (DME).
- A 20% copay for mental health services you receive while in the hospital.
- A $200 per day coinsurance for skilled nursing facility stays between 21 and 100 days. After day 100, Part A won’t cover any costs.
- If you do have to pay a monthly premium for Part A because of your work history, you may pay up to $506 per month.
Medicare Part B
Medicare Part B is also called medical insurance. It covers:
- Ambulance services
- Clinical trials
- Durable medical equipment (DME), including crutches, walkers, wheelchairs, blood sugar monitors, and oxygen equipment
- Limited outpatient prescription drugs
- Mental health services
- Urgent care
Unlike Part A, Part B has a monthly premium. In 2023, the standard monthly premium was $164.90, but your premium may be higher based on your income.
Part B also has deductibles and copays, including:
- A $226 annual deductible
- A 20% copay after you meet the annual deductible. This means you will pay 20% of the Medicare-approved amount for most doctor services, treatments, outpatient therapy, and durable medical equipment (DME).
You could also pay a penalty if you enroll late in Part B. This penalty is applied to your monthly premium.
Medicare Part C
Medicare Advantage Plans, or Medicare Part C, are offered through Medicare-approved private insurance companies. At a minimum, Medicare Advantage Plans must cover all the services offered as part of Original Medicare, except hospice care.
Generally, these plans also cover services Original Medicare doesn’t cover, such as:
- Fitness programs (gym memberships)
- Over-the-counter medicine
- Prescription medicine
- Routine hearing exams, hearing aids, and fittings
- Transportation to doctor appointments
- Vision exams and eyeglasses
Keep in mind that each Medicare Advantage Plan is different, and coverage can vary. Costs for these plans also vary, although some may offer a $0 monthly premium. It’s always a good idea to review coverage and costs before signing on to any Medicare Advantage Plan.
Medicare Part D
Medicare Part D includes Prescription Drug Plans (PDPs). Since Original Medicare doesn’t cover most prescription drugs, you may consider a Part D plan if you want to avoid high out-of-pocket costs for medications.
Similar to Part C Medicare Advantage Plans, PDPs are offered through private insurance companies. Premiums, copays, and deductibles can vary across plans. The types of drugs covered in each plan also vary.
It’s important to remember that Part D plans can have a penalty if you enroll late. Your premium may also be higher depending on your income
If you’re interested in learning whether Medicare is right for you, we’re ready to help. Are you ready to talk to one of our specialists about Medicare plans? Please call us at 305.541.5366 to schedule an appointment or learn more about the Medicare plans offered through LEON Health.