4 things to know about Medicare:
- Medicare is a federal health insurance program.
- Medicare covers senior citizens and people with disabilities.
- Medicare comes in 4 parts: Parts A, B, C, and D.
- Medicare Parts A & B are funded by the government. Parts C & D are provided by private health insurance companies.
Medicare as the federal health insurance program for people age 65 and older, and certain younger people with disabilities.
Over 61 million people are enrolled in Medicare, according to 2019 data from the Centers for Medicare and Medicaid Services (CMS).1
What Are the Parts of Medicare?
There are four parts of Medicare: Part A, Part B, Part C, and Part D. Each part covers different services.
- Medicare Part A and Part B are provided by the federal government
- Part C and Part D are provided by private insurance companies.
Medicare terminology can get a little confusing. The different parts are also often referred to in the following ways:
- Parts A & B combined: Original Medicare
- Part C: Medicare Advantage
- Part D: Prescription Drug Coverage
What does Medicare cover?
Each part of Medicare provides different health care benefits:
- Medicare Part A covers hospital and other inpatient care. Most people qualify for “premium-free” Part A after having worked and paid taxes for a certain amount of time.
- Medicare Part B is optional and provides medical insurance that covers doctors visits, lab tests and many other outpatient services along with medical equipment. Part A and Part B together are referred to as Original Medicare.
- Part C is also known as Medicare Advantage, and is a set of private health insurance plans designed as an alternative to Original Medicare. These plans must provide at least the same minimum benefits as Original Medicare and may also offer additional benefits.
- Part D plans are private Medicare prescription drug plans.
Medicare Part A hospital insurance
Part A offers hospital insurance benefits and is the first half of Original Medicare. It covers inpatient hospital stays, hospice care, and skilled nursing facility care.
In 2019, the deductible for Medicare Part A hospital care is $1,364 per benefit period.
A benefit period under Part A begins the day you’re admitted to the hospital and ends when you’ve been discharged for at least 60 days. If you’ve been out of the hospital for more than 60 days and are admitted again, a new benefit period begins.
You can actually encounter multiple Part A benefit periods in the same calendar year if you’re hospitalized more than once, and each benefit period requires you to meet the Part A deductible.
If you are admitted for inpatient hospital care, you don’t have to pay Medicare Part A coinsurance for your first 60 days of your stay. However, you may face coinsurance costs for longer stays.
- If you’re in the hospital between 61 and 90 days during one benefit period, each day will cost $341 in 2019.
- If you’re in the hospital for more than 90 days during one benefit period, each day beyond that will cost $682 in 2019.
- Starting on Day 91, you start tapping into your lifetime reserve days for Medicare Part A. You have 60 reserve days. Once they are used up and you encounter a long hospitalization, you are responsible for all costs starting with Day 91 in the hospital.
Medicare Part B medical insurance
Part B offers medical insurance benefits and is the second half of Original Medicare. It covers outpatient hospital care, preventative care, doctors services, and other services.
You must have Part B to qualify for Medicare add-ons such as Medicare Supplement Insurance (Medigap) and Medicare Advantage.
The standard Medicare Part B premium in 2019 is $135.50 per month, but premiums can vary based on your income. The annual Medicare Part B deductible in 2019 is $185 per year.
Medicare Part C (Medicare Advantage)
Part C is insurance that covers the same things as Original Medicare, but it is provided by private companies and usually includes additional benefits, such as prescription drug coverage, vision, dental, and wellness programs.
Learn more about Medicare Advantage plans and the coverage they can provide.
Medicare Part D prescription drug coverage
Part D is the Prescription Drug Coverage portion of Medicare. The plans are offered by private insurers and not the federal government. It is an optional add-on. The prescription drugs covered and the costs of Part D plans will vary based on the insurance provider.
Medicare eligibility and enrollment
In order to qualify for Medicare coverage, you must be at least 65 years old and a citizen (or permanent legal resident) of the United States. You also may qualify if you are under 65 and have a disability.
Most seniors will be enrolled in Original Medicare automatically. If not, applicants can apply during certain enrollment periods.
Your Medicare Coverage Can Be Supplemented
There are generally up to 10 standardized Medigap plans to choose from in most states, and each plan provides a unique set of benefits.
|Medicare Supplement Benefits||A||B||C||D||F1||G||K2||L3||M||N4|
|Part A co-insurance and hospital costs||✓||✓||✓||✓||✓||✓||✓||✓||✓||✓|
|Part B co-insurance or co-payment||✓||✓||✓||✓||✓||✓||50%||75%||✓||✓|
|First 3 pints of blood||✓||✓||✓||✓||✓||✓||50%||75%||✓||✓|
|Part A hospice care co-insurance or co-payment||✓||✓||✓||✓||✓||✓||50%||75%||✓||✓|
|Co-insurance for skilled nursing facility||✓||✓||✓||✓||50%||75%||✓||✓|
|Medicare Part A deductible||✓||✓||✓||✓||✓||50%||75%||50%||✓|
|MedicarePart B deductible||✓||✓||✓|
|Medicare Part B excess charges||✓||✓||✓|
|Foreign travel emergency||80%||80%||80%||80%||80%||80%|
|1. Plan F offers a high-deductible plan. This plan requires you to pay a $2,300 deductible in 2019 before it covers anything.
2. Plan K has an out-of-pocket yearly limit of $5,560 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
3. Plan L has an out-of-pocket yearly limit of $2,780 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
4. Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.
Call today to speak with a licensed insurance agent who can help you compare Medicare Supplement plans that are available in your area. Find a plan that can help cover your out-of-pocket Medicare costs.
Compare Medigap plans in your area.
Or call 1-800-995-4219 to speak with a licensed insurance agent.
1 Medicare Enrollment Dashboard. CMS. Retrieved Aug. 2019, from www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Dashboard/Medicare-Enrollment/Enrollment%20Dashboard.html.