What Medicare Covers
Medicare provides healthcare coverage to those 65 and older, as well as people with disabilities and some chronic diseases, through five major options:
- Part A of Medicare covers part of your hospitalization.
- Part B of Medicare covers part of your outpatient treatment, such as doctor visits and diagnostic tests.
- Part C (Medicare Advantage) is also known as an ‘All-In-One Plan’ that combines Part A, Part B and Part D into a plan that’s very much like a health insurance plan. It also adds on other benefits such as Vision, Dental and Hearing that Part A and B (Original Medicare) do not cover.
- Part D of Medicare covers Prescription Drug coverage, if you do not get it through your Medicare Advantage Plan and have Original Medicare you must purchase a stand-alone Part D Plan to avoid penalties and have Prescription coverage.
- Medicare Supplement (Medigap) is an option plan you can purchase if you have Original Medicare (Part A and B) that helps cover out-of-pocket costs like coinsurance and deductibles it does not cover or give you any additional benefits.
When it comes to healthcare, it’s critical to understand what is and isn’t covered. Because there are so many different Medicare plans, it can be difficult to figure out which one would provide you with the best coverage. Fortunately, there are several tools available to assist you.
Medicare is the federal government’s health-care insurance program for adults 65 and older, as well as people with disabilities and those with end-stage renal disease (ESRD), a kind of kidney failure.
5 Things You Might Not Know About Medicare
The Medicare plan is divided into four sections: A, B, C, and D. Each section delves into a different topic of healthcare. You can sign up for one or more components of Medicare, but the most prevalent are parts A and B, together known as Original Medicare. The average person that has spent more than 10 years working/paying taxes usually gets Part A for premium-free, but this depends on your work history. People are normally required to pay a monthly premium for Part B, the amount varies depending on their income.
What does Medicare Part A cost?
You may have to pay a premium for Part A coverage depending on your income. You do not have to pay a premium for Part A if you have worked and paid FICA taxes for ten years. You may, however, be required to pay copayments or a deductible for any Medicare Part A services. You can ask for financial aid or assistance if you are unable to pay.
For the year of 2021 Medicare estimates your costs for Part A to be as follows:
Note: Original Medicare covers up to 90 days of in patient hospitalization each benefit period (one year). Anything beyond the 90 days in that one period will be used from your lifetime reserve days. Each person only has 60 lifetime reserve days and they can only be used once in their lifetime.
- 2021 Deductible is $1,484
- For days 1-60 of inpatient hospitalization, there is no coinsurance.
- For days 61-90 of inpatient hospitalization, the coinsurance is $371 each day.
- For days 91+ (up to only 60 additional days also known as lifetime reserve days) of inpatient hospitalization the coinsurance is $742 per day. Once these days are used up you will be liable for all costs.
- For the first 20 days of authorized skilled nursing facility care, there is no coinsurance.
- For days 21-100 of authorized skilled nursing facility care there is a $185.50 per day coinsurance.
- For days 101+ of authorized skilled nursing facility care you will be liable for all costs.
To be covered by Medicare for hospital services, you must be authorized and receive care in a Medicare-approved institution.
Medicare Part B
Part B of Medicare covers your doctor’s services as well as preventive care, such as yearly doctor visits and tests. To get the most coverage, people frequently combine sections A and B. For example, if you remain in a hospital, Medicare Part A will cover your stay, while Part B will cover your doctor’s services.
Part B includes a variety of examinations and services, such as:
- Ambulance and emergency department services for cancer, depression, and diabetes screening
- Vaccinations against influenza and hepatitis
- Diabetes supply medical equipment
What does Medicare Part B cost?
For the year of 2021 the lowest monthly premium for Part B is $148.50 however, your premium may be more depending on your income. Some people qualify for Medicare Savings Program in their state which helps pay for the Part B Premium which also depends on your income level.
If you see a doctor who accepts Medicare, some services are covered under Medicare Part B at no cost to you. If you require a service that is not covered by Medicare, you will be responsible for the cost.
Medicare Part C
Part C, often known as Medicare Advantage, is a offered by insurance companies and is an alternative that includes the same coverage as Parts A and B, as well as additional benefits such as prescription drug plans, dentistry, hearing, vision, and other services. You must be enrolled in Original Medicare (Part A and B) to obtain a Medicare Advantage plan.
What does Medicare Part C cost?
The price of the plan varies but some are even premium-free so most people only pay their normal Part B premium.
As far as Copayments/Coinsurance/Deductibles or other costs go it depends on each plan. The cost of Medicare Part C varies according to the plan you choose. Every plan does have a maximum out-of-pocket cost which Original Medicare doesn’t have. Maximum out-of-pocket is a limit set by each plan of your maximum you would pay towards any Part A or B type service (hospitalization/doctor visits) in a year. Once this limit is reached the insurance company will pay 100%. This does not include your Part D coverage.
Medicare Part D
Part D of Medicare is the plan that covers prescription pharmaceuticals not covered by Part B, which are often treatments that require a doctor’s supervision, such as an infusion or injection. Although this plan is optional, many people choose to get it to have their drugs covered and not be liable to the penalties for not having one.
What does Medicare Part D cost?
The cost of Medicare Part D varies based on the prescriptions you take, your plan, and which pharmacy you use. You will be required to pay a premium and, depending on your income, you may be required to pay additional charges. You may also be required to pay copays or a deductible.
What Medicare doesn’t cover
While Medicare covers a large number of services, it does not cover everything. Original Medicare does not cover dental treatment, eye tests, hearing aids, acupuncture, or cosmetic operations.
Long-term care is not covered by Medicare. Consider purchasing a separate long-term care insurance coverage for yourself or a loved one if you believe you or a loved one will require it.