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Medicare Basics

Introduction to Medicare

Medicare can certainly be confusing. To be sure you’re getting the most from your Medicare coverage, it’s important to understand all of Medicare’s parts and what each one covers.

Even if you’re not 65 yet, you may still be able to take advantage of Medicare. That’s because people of any age who are disabled, have End-Stage Renal Disease (kidney failure), or have amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease), may qualify for Medicare.

To determine if you’re eligible for Medicare, please review our Medicare Eligibility page.

Understanding Medicare Parts A through D

Medicare is made up of four basic parts: Part A (hospital coverage), Part B (medical insurance), Part C (managed care plans), and Part D (prescription drug coverage).

  Part A Part B
What does it cover? Hospital Insurance
Part A covers hospice care, home health care, skilled nursing facilities and inpatient hospital stays.
Medical Insurance
Part B covers physician fees and other medical services not requiring hospitalization.
How do I enroll? Enrollment may be automatic when you become Medicare-eligible, but early enrollment by those without SS or RRB benefits requires manual sign-up. Similarly, certain pre-existing conditions (such as ESRD) require manual sign-up. You must choose to enroll through SS if you aren’t collecting SS or RRB benefits at least 4 months before turning 65. You can choose to delay without penalty if you meet certain criteria.
Is there a premium? You usually don't pay a monthly premium for Medicare Part A (hospital Insurance) coverage if you or your spouse paid Medicare taxes for at least 10 years while working. Yes. The monthly premium for Part B varies depending on when you were first enrolled in Part B and if you are subject to a premium surcharge due to your income level.
What is the deductible? The 2019 Part A hospital inpatient deductible is $1,364. The 2019 Part B deductible is $185 (this amount may be higher depending on your income).
Is there co-insurance? There is no co-insurance for your first 60 days of inpatient care. Part B covers 80% of medically necessary services. You are responsible for the remaining 20%.

Medicare Part C

Also known as Medicare Advantage, Part C refers to private health insurance plans that provide Medicare coverage. Private insurers who offer Medicare Advantage plans are required to provide the same benefits as Medicare Parts A and B, and some carriers provide even more benefits/services.
Medicare Advantage plans:

  • Must be approved by the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees the Medicare program
  • Must maintain a contract with CMS to provide Medicare coverage
  • Can offer prescription drug coverage (see Part D, below) as part of their plan offering
  • May offer additional services/programs not offered by Medicare Parts A & B
  • May require you to use a specific network of doctors and hospitals
  • May require you to pay additional premiums, copayments, coinsurance, deductibles or other out-of-pocket expenses

Medicare Part D

This is Medicare's prescription drug coverage. Sometimes referred to as PDP, Medicare prescription drug plans:

  • Are provided by private health insurance companies
  • Can be offered as stand-alone plans or as part of a Medicare Advantage plan
  • May require you to use specific pharmacies or get some of your medications by mail

How Much Does Medicare Cost?

Part A is free for most people, as long as you are already receiving benefits from Social Security, or if you or your spouse paid Medicare taxes while working.

Part B requires you to pay a monthly premium, which can change from year to year.

Prices vary based on your selected plan and insurance carrier.