When you reach the age of 65, you become eligible to enroll in Medicare.
Trying to navigate the enrollment process can be tricky, though. What’s even more difficult to understand are all the different components of Medicare. Trying to determine which parts are necessary for your long term health can be complicated and we hope to help you gain a better understanding of this today.
So, we’ll cover some basics about the Medicare program, we’ll recap the various different elements of Medicare and we’ll also discuss some services that are covered.
Firstly, a basic definition of Medicare…
What Is Medicare?
In the United States, once a citizen reaches a certain age, they are eligible to enroll in Medicare.
This program is a national health insurance program for US citizens and qualifying permanent legal residents.
While generally reserved for those over the age of 65, Medicare can also be used by younger people in certain situations. With proof of two years’ worth of Social Security disability payments, disabled people also qualify for the most common parts of Medicare.
There are many different Medicare plans available so it can be hard to figure out which plan is the best for your situation.
We’ll dive a little deeper into that right now…
4 Parts Of Medicare
The Medicare program consists of 4 separate parts.
Part A and Part B are considered the original Medicare program although things have been further split apart in recent years.
Generally, all enrollees are entered into Medicare Parts A and B with Parts C and D being optional.
If this seems immediately confusing, we aim to clear things up for you!
What’s Covered By Part A – Inpatient Hospital Services
Medicare’s Part A covers costs associated with inpatient hospital care, care in a nursing home, home health care, care in a skilled nursing facility, and in home hospice care.
This isn’t quite as straightforward as it seems, though. While Medicare Part A covers things like in-home hospice care, it won’t cover long-term care in a hospice facility.
Beyond this, Medicare Part A doesn’t cover emergency room visits and is limited to inpatient hospital care. To establish whether your stay is covered, you’ll need to know if treatment is inpatient or outpatient.
If you are seen at the hospital and receive x-rays, outpatient surgery, laboratory tests or emergency services, all of this care is deemed outpatient and not covered by Medicare Part A unless you are admitted to the hospital formally by doctor’s order.
Inpatient care begins when you are admitted to the hospital on the orders of a doctor. If you are receiving these services while inpatient, they will be covered.
Costs Associated With Medicare Part A
While Medicare Part A is cost-free for some, others have to pay monthly premiums for care as well as deductibles and co-pays.
The amount you will be expected to pay depends largely on your income.
Part B – Doctors and Diagnostics
Medicare’s Part B helps cover the costs associated with medical testing and other outpatient services provided to you.
Where Medicare Part A covers only inpatient care, Medicare Part B covers the testing and checkups that comprise preventative healthcare.
Some of the services provided under Part B of Medicare include:
- Ambulance services
- Care in the Emergency Room
- Screenings for diabetes and cancer
- Vaccinations for flu, hepatitis etc
- Some medical equipment
Costs Associated With Medicare Part B
Generally, those covered under Medicare Part A need to buy into coverage with Medicare Part B. Ensuring that both inpatient and outpatient care is covered is important so both programs are necessary.
Medicare Part B charges a monthly premium with the amount you will pay depending on your income.
Usually, if your doctor accepts Medicare, you won’t need to pay anything extra for services provided (as long as they are approved). However, if the service you need is not one that Medicare covers, you will need to pay for it yourself.
Some doctors refuse to accept Medicare and insist upon payment before providing care. You can file a claim to try to recoup a portion of the cost but this takes time.
Part C – Medicare Advantage
Medicare Part C is a supplemental program that allows you to receive additional care for an additional cost.
Working to fill in the service gaps left by Medicare Parts A and B, Medicare Part C is a private insurance plan.
These plans must be approved by Medicare.
If you want to enroll in Medicare Part C, you must also be enrolled in Medicare Parts A and B.
When using Medicare Part C, you can expect more services to be covered including:
- Vision coverage (exams and lenses)
- Prescription drug coverage
- Dental Care (preventative and certain treatments)
- Hearing Care (exams and hearing aids)
Medicare Part C covers everything that is covered under Medicare Parts A and B.
Part C also pulls in the prescription coverage from Part D. Medicare Part C is similar to HMO healthcare plans.
Costs Associated With Medicare Part C
The costs of Medicare Part C are greatly variable depending on what services are covered as well as your location.
There are usually monthly premium payments and sometimes there are deductibles and co-payments that must be met, too.
You must use doctors and services within the network or you will have to pay for the care you receive.
Part D - Prescriptions
Medicare Part D is available as a standalone prescription drug insurance program.
Coverage under Medicare Part D is administered by private insurance companies just like Part C.
If you have a prescription drug coverage plan from another source, you can continue to use it. However, if you have no coverage for prescriptions, you are required to use Medicare Part D.
Costs Associated With Medicare Part D
Depending on the plan you choose and your service area, your costs will vary.
You can expect to pay a premium depending on income and yearly deductibles that must be met before coverage with Medicare Part D kicks in.
So, there you have it. There are 4 different parts to Medicare, and they each cover different services:
- Medicare Part A covers inpatient care
- Medicare Part B covers outpatient care
- Medicare Part C is a combination of Medicare Parts A, B, and D and is administered by private companies
- Medicare Part D provides coverage for prescription drugs
All parts of Medicare require a premium depending on your income and you can expect that there will be co-pays and deductibles associated with your care, too.
Navigating Medicare can be tricky but hopefully today’s quick guide helped!