MEDICARE EXPLAINED

Part A – Hospital Insurance
Part A of Medicare is Hospital Insurance. Hospital Insurance covers inpatient care at hospitals, skilled nursing facilities, hospice care, and home health care. Inpatient hospital care also includes the care you receive at acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, long-term care hospitals, psychiatric care at inpatient psychiatric facilities, and inpatient care for qualifying clinical research studies.

You should sign up for Medicare Part A when you turn 65, regardless if you are signing up for Medicare or delaying it. Part A Hospital Insurance generally has a $0 monthly premium for Medicare recipients due to paying Medicare taxes (for at least 10 years). You will need to speak with the Social Security Administration to determine if your Medicare Part A insurance has a premium of $0 per month. When you hear the term ‘Original Medicare’, think Parts A & B.

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Part B – Medical Insurance (Outpatient Services)
Part B of Medicare covers medical care you receive in an outpatient setting. This includes office visits, ER/Urgent Care, outpatient surgery, radiology labs, and ambulance – ground and air. Part B also includes preventive services including, but not limited to, cardiovascular disease screenings, cervical and vaginal cancer screenings, colorectal cancer screenings, mammograms, some vaccines, and flu shots. For a full list of preventive services, please click on the link titled ‘Understanding Medicare Basics’ located on the ‘Medicare Resources’ tab.
Part B Medicare Insurance has a monthly premium cost determined by your income. To determine your Part B monthly premium, please contact the Social Security Administration. You will sign up for Medicare Part B at the same time as Medicare Part A, unless you are delaying Medicare. If you are delaying Medicare, do not sign up for Medicare part B. When you hear the term ‘Original Medicare’, again, think Parts A & B.

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Part D – Drug Coverage
Part D of Medicare is separate from Medicare parts A & B. Part D is straight forward; it helps cover the cost of prescription drugs. Part D is purchased by the consumer through private insurance companies.

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Part C – Medicare Advantage (also known as Medicare Part C) 
Medicare Advantage is a Medicare-approved plan from a private health insurance carrier that offers an alternative to Original Medicare (Parts A & B) for your health and drug coverage. Medicare Advantage bundles Original Medicare (Parts A & B) with Medicare Part D. Medicare Advantage plans utilize ‘networks’ (similar to Employer Health Insurance), which means plans may offer both in-network and out-of-network options. 

 

Medicare Advantage plans offer additional services that Original Medicare does not, including, but not limited to, dental, vision, and hearing services. Medicare Advantage Plans must offer the same benefits as Medicare Parts A & B.

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Medicare Supplemental Coverage (also known as Medigap Policies) 
Original Medicare (Parts A & B) does not cover all of the cost for covered health care services and
supplies. Medicare Supplements are designed to cover those uncovered costs, which is why you will often hear it referred to as ‘Medigap’. Medigap policies do not cover Long Term Care, dental, hearing or vision services. Medigap policies are standardized, and are sold through private insurance companies.​