Part A (Hospital Insurance): Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.
Part B (Medical Insurance): Services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, many preventive services.
Part D (Drug coverage): Helps cover the cost of prescription drugs (including many vaccines). You join a Medicare drug plan in addition to Part A and/or Part B, or by joining a Medicare Advantage Plan that includes drug coverage.
Part C (Medicare Advantage): Medicare Part C, also called Medicare Advantage (MA) , are private insurance plans offered by Medicare-approved companies. These plans provide most of Part A (Hospital Insurance) and Part B (Medical Insurance) coverage and typically offer extra benefits such as vision, hearing and dental care. Many Medicare Advantage plans include Part D coverage.
Original Medicare includes both Part A (Hospital Insurance) and Part B (Medical Insurance). It is a fee-for-service health coverage managed by the federal government. After you pay a deductible, Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance and deductibles). Original Medicare does not include Part D prescription drug coverage.
Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage in a manage plan such as an HMO or PPO.
Unlike Original Medicare, these plans set a limit on what you’ll have to pay out-of-pocket each year for covered services. Medicare Advantage Plans may also offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).
Generally, Medicare is health insurance for people 65 or older. You’re first eligible to sign up for Medicare 3 months before you turn 65. You may be eligible to get Medicare earlier if you have End-Stage Renal Disease (ESRD), ALS (also called Lou Gehrig’s disease), or have a disability and receive Social Security Disability Insurance after a 24-month qualifying period.
People who do not enroll in Medicare when they become eligible may have to pay a penalty if they decide to enroll in Medicare later. This is true for Part B, Part D, or those who do not qualify for premium free Part A.
If you maintain creditable coverage through a larger employer group plan, federal employee health plan or union coverage plans then can delay Medicare coverage. Creditable coverage needs to be equal or greater than what Medicare covers. NOTE: COBRA does not count as creditable coverage.
With a few exceptions, most prescriptions aren’t covered in Original Medicare. You can add drug coverage by joining a Part D prescription drug plan.
Medicare related costs include premiums, deductibles, coinsurance for Part A, Part B, and Part D. If you only have Original Medicare, there is no yearly limit on what you pay out-of-pocket for hospital, medical, and prescription drugs. See additional FAQs for specific costs on Part A and Part B.
Part A costs: The premium for most people is $0. If they have less than 10 years paying into Medicare and don’t qualify for premium-free Part A then you may be able to buy for either $278 or $506 per month. The deductible for Part A in 2023 is $1,600 for each inpatient hospital benefit period before Part A kicks in to pay. There’s no limit to the number of benefit periods you can have in a year. This means you may pay the deductible more than once in a year.
After your deductible, you will pay the following copayments for your inpatient stay as follows: Days 1-60 = $0, Days 61-90: $400 copayment each day, Days 91-150: $800 copayment each day using your lifetime reserve days. After day 150 you pay all costs.
Skilled Nursing Facility stay is covered after meeting the 3-day rule requirement at 0$ copayment for days 1-20, $200 copayment per day for days 21-100. for days 101 and beyond, you pay all costs.
Part B Costs: Part B has a monthly premium of $164.90 per month in 2023. The amount can change each year. You’ll pay the premium each month, even if you don’t get any Part B-covered services. This premium amount could be higher if your income is above $97,000 for individual or $194,000 for married joint returns. If you are low income and qualify for the Medicare Savings Program then you could get assistance paying the premium.
The 2023 deductible is $226 before Part B starts to pay. After the deductible, you pay 20% of the costs for Medicare-covered services. There is no max out-of-pocket limit on what you pay for Part B services each year.
Medicare Part D costs can include a premium, deductible and copays/coinsurance. However, the actual costs can vary depending on multiple factors; including your prescriptions, the plan you choose, the drug phase, drug tiers, pharmacy choice, and if you qualify for extra help or are required to pay an income adjustment due to high income earner. It is best to speak with our licensed agents to search for plans that cover you prescriptions at the lowest out-pocket-costs.
The average monthly premium for a stand-alone Part D plan is $31.50, but some plans have much lower premiums, and if you choose a Medicare Advantage with Prescription Drug coverage then there are many plans with $0 premium.
In most cases, if you don’t sign up for Medicare or Part D when you’re first eligible, you may have to pay a higher monthly premium. These penalties are not a one-time penalty and are usually charged for the duration of your Medicare coverage. The longer you wait to enroll, the higher your penalty will be because it is based on how many months you went without coverage. Our agents can help you determine if you have a penalty and how much that could cost.
Part B late penalty: you’ll pay an extra 10% for each year you could have signed up for Part B, but didn’t.
Part D late penalty: You’ll pay an extra 1% for each month (that’s 12% a year) that you don’t join a drug plan when you should.
Part A late penalty: For those who don’t qualify for premium-free part A, your monthly premium may go up 10% and you’ll have to pay the penalty for twice the number of years you didn’t sign up
NOTE: Low-income individual may get help paying their late penalties.
There are programs offered through your state’s Medicaid office and social security that can help lower your Medicare and prescription drug costs.
The Medicare Savings Program can help pay for Part A and Part B premiums, deductibles, and coinsurance.
Extra Help is a low-income subsidy that can help reduce prescription drug costs, including premiums, deductibles and copays.
This question depends on which coverage option you choose.
If you have Original Medicare, then in most cases you can go to any doctor, health care provider, or facility without a referral as long as they are enrolled in Medicare and accept Medicare patients. Always call the provider before you go.
Medicare Advantage plans do have networks of providers. If you have a PPO plan, then you can go to any doctor in or out of the network, but the costs out of network can be higher. If you have an HMO plan, then you will need to go to providers in network to get coverage.
If you have a Medicare supplement plan, then it still covers all the providers that accept Original Medicare.