MEDICARE PART A:

Medicare Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Most of the time, you do not have to pay a monthly premium for Part A coverge, as long as you or your spouse paid Medicare taxes for at least 40 quarters while you were working.

When you use your Part A benefits, there is a large deductible ($1632 per benefit period in 2024) that needs to be met before Part A starts paying your health care costs. The Part A deductible is not an annual deductible. It applies and is charged to you for each benefit period. A benefit period begins when you are admitted to the hospital and ends when you have been out of the hospital or skilled nursing facility for 60 consecutive (in a row) days.

For example, if you are hospitalized on January 15, 2024, then you are responsible to pay a $1632 deductible. If you are released from the hospital on January 25, 2024, then that benefit period ends once you have been out of the hospital or skilled nursing facility for 60 days in a row. If you are admitted to the hospital again on August 1, 2024, then a new benefit period begins and you are once again charged the $1632 deductible since it is considered a separate benefit period.

MEDICARE PART B:

Medicare Part B helps cover medically necessary services and supplies needed to diagnose and treat a medical condition including services from doctors and other health care providers, outpatient care, durable medical equipment, many preventative services and some home health care.

There is a monthly premium ($174.70 in 2024) that you are responsible to pay. If you are receiving Social Security, your Part B premium can be withdrawn directly from your Social Security check. Otherwise, you would need to pay the premium 3 months at a time from your checking account.

There is a once a year deductible ($240 in 2024) that you would have to pay before Part B coverage begins. After you meet your deductible, then Part B pays 80% of Medicare approved charges. You are responsible for 20% of the costs of service.

Original Medicare (Part A & Part B) has no yearly limit on what you could have to pay out of pocket.

Medicare recipients who are considered high income beneficiaries may pay a higher monthly premium for their Part B coverage.

MEDICARE PART C:

Medicare Part C is also called Medicare Advantage (MA or MAPD) and is an alternative to Original Medicare. Medicare Advantage plans may include prescription drug coverage, along with other extra benefits. It is offered through and administered by private insurance companies.

While these plans do have a yearly limit on your out of pocket costs, that limit varies based on your specific plan. Additionally, these plans utilize HMO and PPO networks in conjunction with copayments and coinsurance for services received.

In order to have Medicare Part C, you must have Medicare Parts A & B. If you have a Medicare Advantage plan, then it becomes your Primary Insurance, but you must continue paying your Part B premiums.

When you have a Medicare Advantage plan, you can not buy and do not need a Medicare Supplement policy. Furthermore, Medicare Part D (Drug Coverage) is included in most Medicare Advantage plans; you can not join a separate Medicare drug plan.

MEDICARE PART D:

Medicare Part D helps pay for your prescription drugs. Part D coverage is available as a Stand Alone Drug Plan (PDP) or as part of a Medicare Advantage plan. Part D plans are offered by private insurance companies contracted and approved by Medicare.

If you decide not to get Part D when you are first eligible and you do not have other creditable prescription drug coverage, then you will likely pay a penalty if you enroll at a later date.

How much you pay for your prescription drugs and your Part D plan will depend on the plan you choose and your specific medications. You may have to pay a monthly plan premium, deductible, copayments or coinsurance throughout the year.

To learn more about your options--having Original Medicare with a Supplement and Drug Plan OR choosing a Medicare Advantage plan, please click one of the buttons below.

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