Medicare, the federal program for healthcare insurance, has multiple parts and you need to know how they work. Below we’ll teach you the parts, coverage, and costs of Medicare and how you can enroll when you’re eligible.
The Parts of Medicare
Medicare Part A and B make up Original Medicare. Beyond that are Medicare Advantage, Part D, and Medicare Supplement plans.
Medicare Part A is your hospital insurance. It covers care as an inpatient in a hospital or skilled nursing facility as well as hospice care and home health care.
Medicare Part B is your medical insurance. It covers medically necessary and preventive care, including things like clinical research, ambulance services, durable medical equipment (think CPAP devices, infusion pumps, walkers, wheelchairs, etc.), mental health care, and limited outpatient prescription drugs.
Part C, Medicare Advantage, is offered by private Medicare-approved insurance companies. These plans provide your Part A and Part B care as well as additional services such as prescription drug coverage (look for a Medicare Advantage + Prescription Drug (MAPD) plan), or packages for hearing, dental, and vision care.
Part D is Prescription Drug coverage. Plans will have coverage for generic, name-brand, and specialty prescription drugs. Your copayment at the pharmacy depends on which category your drug falls under, as well as whether or not it is preferred by your plan.
Medicare Supplements, also known as Medigap, help cover the out-of-pocket costs from Part A and Part B. That can include Part A hospital, skilled nursing facility, or hospice costs, Part A coinsurance or copayments, the Part A deductible, Part B copayments or coinsurance, Part B excess charges, and emergency care during foreign travel.
What Medicare Doesn’t Cover
Original Medicare does not cover the following:
- routine dental care or dentures,
- routine hearing care, hearing aids, or fittings,
- routine vision care, eyeglasses, or contacts,
- routine foot care,
- long term care,
- cosmetic surgery, or
- acupuncture.
The Costs of Medicare
Generally, you will need to pay premiums, deductibles, copayments, and coinsurance for Medicare Part A and Part B. Most people pay nothing in premiums for Part A. Deductibles for Part A are charged for each benefit period, which begins when you are admitted as an inpatient and ends when you have gone 60 days without receiving inpatient care.
Costs for Medicare Advantage, Part D plans, and Medicare Supplement plans will differ because they are sold by independent insurance companies. You can expect to pay premiums, deductibles, copayments, and coinsurance for Part C and Part D. For Medicare Supplement plans, you pay premiums and a deductible before your plan will help pay for your healthcare expenses.
How to Enroll
Three months before the month you turn 65, you can begin enrolling in Medicare. Your coverage will begin on the first day of your birthday month if you enroll in these three months. Enrolling during your birthday month or in the three months after means your coverage starts a few months later.
To enroll during your Initial Enrollment Period, visit your local Social Security office, apply online at Social Security’s website, or call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778).
