Medicare Coverage

If you’re eligible for Medicare and ready to enroll, you need to understand what Medicare covers. Medicare is broken down into four parts and each part includes a different set of benefits. Learn more below.

Part A — Hospital insurance

Medicare Part A is known as hospital insurance. It helps pay for costs related to inpatient hospital care, in addition to: 

  • Skilled nursing facility care
  • Hospice care
  • Some home health services

How to qualify

For most people, Medicare Part A is premium-free, meaning you won’t have to pay a monthly premium for your coverage.

Here’s how to qualify for premium-free Part A if you’re 65 or older:

  • You already receive Social Security or the Railroad Retirement Board benefits
  • You are eligible to receive Social Security or Railroad Retirement Board benefits
  • You or your spouse has paid Social Security taxes for at least 10 years (40 quarters)

Part B — Medical insurance

Medicare Part B is known as medical insurance. You can think of Part B as coverage for your medical services, like doctor visits. Part B includes things like:

  • Clinical Research
  • Durable medical equipment
  • Ambulance services
  • Inpatient and outpatient mental health
  • Partial hospitalization for mental health
  • Getting a second opinion before surgery

How to qualify

The requirements to qualify for Medicare Part B are the same as they are for Part A. In fact, you must be enrolled in Part A to enroll in Part B. But unlike Part A, you typically must pay a monthly premium for Part B.

If you receive Social Security, Railroad Retirement Board or Office of Personnel Management benefits, your monthly premium will automatically be deducted from your benefit check. The standard monthly premium for Part B is $144.60 in 2020, though many people pay less. Some people pay more if they have a higher income.

Part C — Medicare Advantage

Medicare Part C, also called Medicare Advantage, is an alternative to Original Medicare. Instead of receiving health benefits from the traditional government health insurance program, you receive your benefits from a private health plan.

Medicare Advantage plans are offered by private insurance carriers. Each plan must provide at least the same benefits as Original Medicare, but they may include additional benefits — like coverage for prescription drugs, dental care and vision care, among others.

Availability varies by location, and costs can vary by each individual plan. Medicare Advantage plans may also include provider networks and other stipulations.

How to qualify

In order to qualify for Medicare Advantage, you must already be enrolled in Medicare Part A and Part B. From there you will need to contact a Medicare-approved private insurance company in your area to find out plan specifics and costs.

Those with End Stage Renal Disease usually can’t enroll in a Medicare Advantage plan.

Part D — Prescription drug coverage

Medicare Part D is prescription drug coverage. You can obtain coverage for your medications either through a Medicare Advantage plan that offers drug coverage (MA-PD), or through a standalone Prescription Drug Plan (PDP) that can be used with Original Medicare or a Medicare Advantage plan that doesn’t offer drug coverage.

PDPs are also sold by private insurers, and there may be a number of plans available where you live.

 

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