Medicare 101 | Your Medicare Helper

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Here's the 101 on Medicare

Medicare is federally managed healthcare for persons over 65, with certain disabilities or with End-Stage Renal Disease. To qualify for Medicare you (or your spouse) must have worked 10 years in the United States. There are four parts to Medicare: parts A, B, C and D.

Medicare Part A is also known as Hospital Insurance

This coverage includes most inpatient care for hospitals as well as some coverage for skilled nursing, hospice and home health.
This coverage is an entitlement and costs you nothing as long as you meet the above mentioned requirements.
There is no network. You may utilize any hospital that accepts Medicare Part A as a payer source.
You can either stay with Original Medicare (A&B) OR enroll in a Medicare Advantage Plan (Part C – below), but not both simultaneously.

Medicare Part B is also known as Medical Insurance

This coverage includes virtually all other medical expenses except those covered by part A.
This includes visits to your primary physician (and doctors at the hospital), specialists or therapy services (such as physical, occupational or speech therapies), blood work, lab work, x-rays, durable medical equipment, surgeries and preventative services.
You pay a premium for part B monthly based on your income. This can be deducted from your social security check, or paid out of pocket.
For those in higher income brackets, the premiums are higher.
There is also a penalty for NOT enrolling in part B when you are first eligible for Medicare. This is important and many people inadvertently delay enrollment causing unnecessary penalties (in certain circumstances, however, these penalties can be avoided).
There is no network and you may visit any provider (doctor, urgent care, facility or otherwise) that accepts Medicare Part B as a payer source.
Parts A&B combined will cover 80% of all Medicare approved charges.

Medicare Part C is also known as Medicare Advantage

This is where its gets REALLY confusing as these plans are essentially a different option entirely than “traditional” Medicare.
These plans are either HMO’s or PPO’s and thus require you to use doctors and networks that are in-network.
These plans are sold by private insurance companies (not the government) and combine the benefits of A & B and often include drug coverage.
Costs of these plans very depending on the carrier, county of residence and plan selected.
You must have A & B to enroll in a Medicare Advantage plan, so you will still pay your Part B premium in addition to the premiums charged for these plans
You can either enroll in a Medicare Advantage plan OR stay with Original Medicare, but not both simultaneously.

Medicare Part D is Prescription Drug Coverage

These are offered through private insurance companies to assist in covering the cost of prescription drug plans
Plans are optional to enroll but you will pay a penalty if you do not enroll in a part D plan when you are first eligible to Medicare
Plan options and costs vary by county of residence – usually 20 to 30 plans exist.