Nearing age 65? You may have many questions about Medicare and what’s best for your individual needs. We’re taking a few minutes today to answer a few of the most common questions.
Navigating Medicare can be confusing. It may even sound a bit like alphabet soup when you start hearing about parts A, B, C, and D!
What should you know as you prepare to enroll? Keep reading to learn the basics.
1. What is Medicare?
Medicare is a federally supported health insurance program for those ages 65 and older, along with younger people who receive disability benefits through Social Security.
There are four different parts of Medicare—A, B, C, and D. Standard (or “original”) Medicare includes Part A, which covers hospital care and related services, and part B, which covers medical appointments and other outpatient medical care.
Part C covers the same services as parts A and B but is offered through private insurance companies. Part D covers prescription medications and is also separate from original Medicare.
2. What does Medicare pay for?
The individual parts of Medicare pay for different things. If you’re enrolled in original Medicare, encompassing parts A and B, your benefits will pay for most of the costs associated with inpatient hospital stays (Part A) and outpatient medical visits (Part B).
There is some cost sharing involved with both Part A and Part B. While there is no monthly premium associated with Part A for most people, those who are hospitalized will pay a deductible of $1,600 for each hospital stay. If a person is hospitalized for longer than 60 days, additional cost-sharing is required on a per day basis.
Part A also provides coverage for stays in a Skilled Nursing Facility for rehabilitation purposes, along with hospice care and some home health services.
For Part B, you pay a monthly premium that varies by income and by year. Before your Medicare Part B coverage kicks in each year, you’ll pay a $226 deductible. After that, you’ll pay around 20% of the cost for covered services, including outpatient physician appointments, lab tests, preventive services, and durable medical equipment.
Part D covers the costs of prescription medications. The cost you’ll pay varies by the specific plan you’re enrolled in, and you’ll usually pay both a premium and a copay for individual medications. You may also have a deductible for your Part D coverage.
3. What is Medicare Part C?
Part C probably seems like an outlier. That’s because, unlike Parts A, B, and D, Part C doesn’t offer unique or distinct services.
Instead, it’s a private health insurance alternative to original Medicare. Like traditional Medicare, Medicare Part C—more familiarly called Medicare Advantage—covers both parts A and B.
Under Medicare Advantage plans, the costs you pay vary. That’s because, like with employer-based insurance, Medicare Advantage coverage is through individual insurance companies, which set the price of the services you receive. Most Medicare Advantage plans also offer Part D coverage for prescription medications.
The insurance companies affiliated with Medicare Advantage plans determine a network of coverage, meaning that some medical providers will be “in network,” while others will not. Costs will be higher if you see a provider or visit a hospital that’s outside your plan’s network.
When you have a Medicare Advantage plan, you still pay a monthly premium for Part B coverage, along with a premium for the Medicare Advantage plan. In many cases, though, the actual services themselves will cost you only a flat copayment, rather than a percentage of the total cost like under Medicare Part B.
4. What’s the difference between a Medicare Advantage plan and Medicare Supplement?
You also have another option when it comes to Medicare. You can choose to have original Medicare that’s supplemented by additional coverage—what is often referred to as a “Medigap” plan.
When you have a Medicare Supplement plan, you enroll in original Medicare parts A and B, along with Part D, if you choose. Supplement plans, which are run by private insurance companies, pick up some of the costs you pay under traditional Medicare, including help with your Part A and Part B cost sharing, like premiums, deductibles, and copays.
The key difference between a Medicare Advantage plan and a Medicare Supplement plan? If you enroll in a Medicare Supplement plan, you are receiving services through original Medicare parts A and B.
5. What Medicare plan is right for me?
It’s a highly individualized decision! Your answer to the question may also evolve over time.
For example, if you are employed after age 65, you may hold off on enrolling in Medicare Part B while you still have employer-based coverage. Eventually, you would need to pick up Part B coverage.
When you are looking to make a decision about what type of plan to enroll in, you’ll want to consider many factors, including your income and other expenses. You will also want to confirm that any plan you select will cover your existing medical providers and the medications and healthcare services you currently use.
Need help making sense of Medicare and how to enroll? Northeast Georgia Health System has partnered with MedicareCompareUSA to offer resources that may help. Call (866) 391-7734 or visit www.nghs.com/medicare to get started!