PART A of Medicare is your hospital insurance. This part of Medicare provides you a semi-private room for your hospital stay and with meals and medical services while you are in the hospital. It also helps cover common hospital expenses for services. A few such examples are hospice, home health care and skilled nursing facilities, as well as blood transfusions requiring more than three pints of blood. Part A is premium-free for most people as long as they have worked at least 10 years (or 40 quarters) and paid into social security in the United States, or are married to someone who is at least 62 and has worked for that amount of time. Sometimes particularly healthy people wonder if they may need only Part A. Perhaps they don’t use many medical services yet and so they wonder if they can get away with Part A alone. They do not take into account that there are many things that happen in a hospital that fall under another part of Medicare – Part B, so it’s important that you enroll in both A & B unless, you have other coverage coordinating with Medicare such as VA insurance.
PART B of Medicare is for outpatient services that are deemed medically necessary. Medicare Part B includes coverage for services like doctor office visits, lab testing, diagnostic imaging, preventive care, surgeries, ambulance rides, chemotherapy and radiation, and even extensive dialysis care for people with renal failure. Although many of these procedures may occur in a hospital, some may fall under Part B since they are provided by physicians, so it’s not always easy to determine what is inpatient versus outpatient care. Sometimes people will ask us if they really need Part B. The answer for most people is absolutely, especially if Medicare will be your primary coverage or only coverage. Parts A and B together make up what we call “Original Medicare”. They are the only two parts that you will sign up for at the Social Security office or Railroad Retirement Board. Even if you select a Medicare Advantage or a Medicare Supplement Plan (Medigap), you will still sign up (and pay for) for Medicare Parts A and B. Many people pay for their Part B premium directly from their Social Security check.
Part C (Medicare Advantage) plans typically combine Parts A, B and D in one plan; though, some Medicare Advantage plans are available without Part D prescription drug coverage (i.e. when you already have creditable prescription drug coverage through another source, such as the VA). Medicare Advantage plans often include additional coverages such as vision, hearing care, dental and even gym memberships. A Medicare Advantage plan may resemble a group plan you are used to from a previous employer. Often times, it will be an HMO, or a Networked group of doctors and medical practitioners. You will still be able to utilize the plan when out of your coverage area for covered Emergency and Urgent care services. However, it’s important to bear in mind, your Primary Care Physician and main network of medical specialists will be within the Network. Additional perks of Medicare Advantage Plans may include Over the Counter credits which are added to your account quarterly.
Part D is your prescription drug coverage. Unlike Medicare Part A and B, you will not enroll in Part D through the Social Security office. Instead, you will select one of the Part D plans available in your area from private insurance carriers. Medicare drug plans are optional. You’ll have a monthly premium that you will pay to the insurance carrier. In return, they give you significantly lower copays on your medicines than you would pay if you had no Part D insurance. There are rules for when you can enroll and disenroll from these drug plans, so be sure to visit the Medicare Part D section of our website for more details about how your drug coverage under Medicare will work. Like Parts A and B, if you do not sign up for Part D, you will face penalties if you enroll later. Please note that most since most Medicare Supplement plans do not provide creditable Part D coverage, you will want to enroll in Part D separately to avoid penalties down the road if your plan does not.
Medicare Supplement Insurance (aka Medigap) are used to help pay for some of the healthcare services covered/allowed by Medicare but not fully paid for. In other words, it helps fill some of the gaps of Original Medicare coverage. There are different Medicare Supplement Plan Options, G and N are the most popular plans available on the market currently.