Medicare basics
Medicare offers different options for you to get health care coverage. Start here to get the basics and find out how Medicare works before you look at your coverage options.
There are four parts to Medicare. Original Medicare consists of Parts A and B. They are administered by the federal government. Part C of Medicare is called Medicare Advantage. Medicare Advantage plans are sold by private health insurance companies that contract with the government. These plans work in conjunction with Original Medicare. Part D provides coverage for prescription drugs. In many Medicare Advantage plans, Parts A, B, and D are bundled into. In addition, each Medicare plan covers only one individual.
Parts of Medicare
There are four parts to Medicare: Hospital Insurance (Part A), Supplementary Medical Insurance (Part B), and Medicare Advantage (Part C) and Prescription Drug Coverage (Part D).
Hospital Insurance (Part A)
Hospital insurance helps pay for inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. For most people, Medicare Part A covers the first 60 days of these health care services following a three-day hospitalization. After that period, you are responsible for all of your expenses unless you have other health insurance.
There are no premiums for people who have paid Medicare taxes for at least 10 years. People with fewer than 30 quarters may be required to pay a monthly premium, which is adjusted yearly. People receiving Social Security benefits before their full retirement age (FRA) and people with disabilities must pay Part A premiums unless they or their spouse has 40 quarters of Medicare-covered employment.
Medical Insurance (Part B)
Medicare Supplementary Medical Insurance helps pay for medical expenses and some preventive services not covered by Part A. It helps with doctor’s fees, outpatient hospital care, physical therapy, diagnostic tests, kidney disease treatment, durable medical equipment, and some home health care.
By paying a monthly premium, you have coverage throughout the year. The amount of your premium for 2018 is $135.50 a month if you have 30 or more quarters of Medicare-covered employment; otherwise, it’s $243.80 a month.
Medicare Advantage (Part C)
Medicare Advantage plans are available in many areas of the country. These plans, which must meet certain standards, allow you to receive your Part A and B benefits through a private insurer. The plan may charge a monthly premium in addition to what you pay for Medicare Part B.
You can also get your Medicare benefits through a private insurance company. These plans, called Medicare Advantage Plans also known as Part C, combine your Part A and B benefits into one package. In some areas, you have a choice of different types of Medicare Advantage Plans from which to choose.
In addition to providing your Parts A and B coverage, most of these plans include extras such as routine vision and hearing coverage. They also include prescription drug coverage through a plan known as Part D, which can cost extra.
If you have both Medicare Parts A and B, the yearly deductible for Part B applies to most of your out-of-pocket medical expenses.
Prescription Drug Coverage (Part D)
Medicare Part D (Prescription Drug Coverage) is an optional Medicare program designed to help individuals pay for prescription drugs. If you are eligible, the program covers some or all of your drug costs up to a yearly limit.
The purpose of Medicare part D is to provide partial or full reimbursement for prescription drugs. The goal of this coverage is to help remove the burden of purchasing medications. Part D plans are available through private insurance providers who negotiate with pharmacies on your behalf for drug costs. This plan can be used in conjunction with original Medicare (Part A and B).