If your 65th birthday is on the horizon, understanding the different parts of Medicare is critical. Even if you are decades away from Medicare, there might be family members that need assistance understanding the process. Knowing the different options can make sure you make the right decision for your family and your health care needs.
Parts A and B: Original Medicare
There are two components. Part A covers inpatient hospital care, skilled nursing facility costs, hospice services, lab tests, surgeries, and some home health care services. While very few beneficiaries must pay Part A premiums out of pocket, the annually adjusted standard deductibles still apply.1,2
Many pre-retirees are frequently warned that Medicare will only cover a maximum of 100 days of nursing home care, provided certain conditions are met. Part A is the plan with these provisions. Under the current Part A rules, a beneficiary would pay $0 for days 1–20 of care in a skilled nursing facility (SNF). During days 21–100, a $176 daily coinsurance payment may be required.1,2
Knowing the limitations of Part A, some look for alternatives to manage the costs of extended care. Part B covers physicians’ fees, outpatient hospital care, certain home health services, durable medical equipment, and other services that are not covered by Part A.3
Part B does come with some costs, however, which are adjusted annually. The premiums vary, according to the Medicare recipient’s income level, but the standard monthly premium amount is $170.10 for 2022, and the current yearly deductible is $198.1
Part C: Medicare Advantage Plans
Sometimes called Medicare Part C, Medicare Advantage (MA) plans are often viewed as an all-in-one alternative to Original Medicare. MA plans are offered by private companies approved by the federal government. Although these plans come with standardized minimum coverage, the amount of additional protection can drastically differ from one person to the next. This is due to unique provider networks, premiums, copays, coinsurance, and out-of-pocket spending limits. In other words, comparing prices and services offered by different vendors may be the best way to find a Medicare Advantage plan that works for you.3
Part D: Prescription Drug Plans
While Medicare Advantage plans often offer prescription drug coverage, insurers also sell federally standardized Medicare Part D plans as a standalone product to those with Medicare Part A and/or Part B. Every Part D plan has its own formulary, or list, of covered medications. Visit Medicare.gov to explore the formulary and prices of approved drugs for your Part D plan, organized by tier.
Medicare.gov is a great place to start all your research. There, you’ll find answers to your most common questions and more information on the different Medicare plans offered in your area.4
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