Different Medicare Parts and What They Cover

Medicare is a program that is heavily utilized. Nearly 60,000 Americans signed up for Medicare in 2018. This figure is expected to rise steadily over the next few years. Despite its widespread adoption, Medicare remains a program that frequently leaves its beneficiaries bewildered. Each part of Medicare covers a separate set of services and prices. Making the most of your Medicare coverage can be as simple as knowing what each section covers and how much it costs. Continue reading to find out more about Medicare’s various components.

What is Medicare?

Medicare is a health insurance program for adults 65 and older and those with specified health conditions and impairments. The Social Security Administration, which administers Medicare, receives funding from taxpayers. In most cases, your employer will match the 1.45 percent of your wages that you pay toward Medicare. There are four parts to Medicare. Each part deals with a specific type of medical care you might require.

Part A: Hospital coverage

Part A of Medicare covers hospitalization. It provides coverage for short-term inpatient hospital stays and services such as hospice. In addition, it offers some coverage for medical services rendered within the home and in skilled nursing facilities.

If you are eligible for Medicare, you will immediately be enrolled in Part A once you submit your application. Suppose you’ve been hospitalized because of a stroke, a broken hip, or another medical emergency that necessitates rehabilitation in a nursing home or another facility. In that case, this insurance will help pay for your stay there, as well as some of your hospice care and some of your skilled nursing care.

For Medicare Part A, most beneficiaries are exempt from paying a premium. You have already contributed money to the system through Medicare tax deductions from your salary.

However, there is a charge associated with Part A.

You are subject to a sizable deductible when admitted to the hospital under Medicare. The deductible will be $1,556 for 2022; however, it varies yearly. You can purchase a supplemental insurance policy, sometimes known as a Medigap policy, which will pay for the Medicare deductible and some of the costs associated with the other components of Medicare.

Suppose you’re a U.S. citizen or legal permanent resident who doesn’t have enough work history to qualify for Medicare benefits. In that case, you can pay the Part A payment to get into the program.

Medicare Part B: Medical Insurance

Medicare Part B is a type of health insurance that provides coverage for routine medical expenses, such as regular doctor’s visits, visits to urgent care facilities, counseling, the cost of medical equipment, and preventative medical treatment. In general, services that are either medically essential or preventive are covered under Part B of Medicare.

Your doctor will recommend services considered medically necessary to address a problem. Preventive medical services, such as annual checkups and vaccinations against influenza, are essential to maintaining good health. The following are included under Part B:

• appointments at the doctor’s office• Examinations and tests
• Annual checkups and exams
• Vaccines
• Visits to a therapist for speech, occupational, and physical therapy
• Appointments with specialists
• Emergency room visits
• Urgent care services
• Transportation in an ambulance for medical emergencies
• Durable (home) medical equipment

Part C: Medicare Advantage

An alternative to Medicare, Medicare Advantage is a commercial health insurance program. One may understand how an Advantage plan could be a one-stop shop for all the benefits of Medicare.

Parts A and B must still be enrolled in and paid for even if you choose a Medicare Advantage — or M.A. — plan. A Medicare Advantage plan and a private insurance company will be required in addition to the original Medicare plan you’ll need to select.

These insurance policies must cover every aspect of original Medicare, but some also pay for treatments that aren’t covered by Medicare, such as dental and vision care. It’s also worth noting that recent years have seen a significant increase in Medicare Advantage plans, including extra food delivery and transport to and from physicians’ clinics.

Prescription drug coverage is typically included as well in most Medicare Advantage plans. If you’re looking for additional benefits, check to see if your specific plan covers them.

A PPO or an HMO is more likely to be a Medicare Advantage provider than a traditional Medicare Advantage plan (PPOs).

Choosing a primary care physician in an HMO is standard practice. This physician will be responsible for overseeing your medical treatment and may be required to recommend you to a specialist if necessary. With PPOs, you frequently access a large network of doctors and facilities without the need for a referral. You’ll almost certainly be charged more if you visit a medical professional not part of the plan’s network.

Part D: Prescription drugs

Medicare Part D covers the cost of certain prescription medications. A private insurer sells you a Part D plan. Premiums and other charges, like flat copays or a portion of prescription costs, are often associated with each plan. In addition, an annual deductible is possible. As soon as you and your Part D insurance plan have spent a total of $4,430 on prescription medications in a year (2022), you will be liable for paying 25% of the cost of any further prescription drugs you need to purchase that year. If your medication prices keep rising, you may be eligible for catastrophic coverage. 5% of the cost of each of your medications will be your responsibility by 2022 if you’ve spent more than $7,000 on medications (including both your out-of-pocket expenses and the payments made by your Part D insurance plan).

Check on medicare.gov to see if your current medications are in the plan’s formulary, which comprises a list of pharmaceuticals covered by the plan. Since those lists could be susceptible to change at any time, you must check the details of your plan during open enrollment each year.