Medicare has five main options that offer healthcare benefits to people age 65 and older and people with disabilities and some chronic conditions:
- Medicare Part A provides basic hospitalization coverage.
- Medicare part B covers outpatient care like doctor’s visits and diagnostic tests.
- Medicare Part C (Medicare Advantage) is a private option that combines Part A and Part B coverage and offers additional benefits.
- Medicare Part D is prescription drug coverage.
- Medicare supplement (Medigap) is private insurance that helps cover out-of-pocket costs like copays, coinsurance, and deductibles.
When it comes to healthcare, it’s important to know what is covered and what isn’t. Because there are so many different plans for Medicare, it can be confusing to know which plan will give you the right coverage. Fortunately, there are some tools that can make it easier for you.
Medicare is the insurance plan offered by the federal government for people aged 65 and over, as well as people with disabilities and people who have end stage renal disease (ESRD), a type of kidney failure.
There are four parts to the Medicare plan: A, B, C, and D. Each part covers different aspects of healthcare. You can enroll in one or more parts of Medicare, but the most common parts people enroll in are parts A and B, known as original Medicare. These parts cover the majority of services. People usually have to pay a monthly premium, but this varies widely based on income.
Medicare Part A covers hospital inpatient costs when you are formally admitted to a hospital with a doctor’s order. It provides benefits for services like:
- walkers and wheelchairs
- hospice care
- some home healthcare services
- blood transfusions
Part A also provides limited coverage for skilled nursing facilities if you have a qualifying inpatient hospital stay — three consecutive days resulting from a formal inpatient admission order written by your doctor.
What does Medicare Part A cost?
Depending on your income, you may have to pay a premium for Part A coverage. If you have worked and paid FICA taxes for 10 years, you pay no premium for Part A. However, You may have to pay copayments or a deductible for any services under Medicare Part A. You can apply for assistance or help if you can’t pay.
According to Medicare, in addition to a $1,484 deductible, your 2021 Part A costs include:
- $0 coinsurance for hospitalization days 1–60
- $371 coinsurance per day for hospitalization days 61–90
- $742 coinsurance per day for hospitalization day 91 and beyond for each lifetime reserve day
- all costs for each hospitalization day over your lifetime reserve days
- no charge for the first 20 days of approved skilled nursing facility care
- $185.50 per day for 21–100 days of approved skilled nursing facility care
- all costs after 101 days of approved skilled nursing facility care
- no charge for hospice care
For hospital services to be covered by Medicare, you must be approved and receive care in a Medicare-approved facility.
Medicare Part B covers your doctor’s services and preventive healthcare, such as yearly doctor visits and tests. People often have parts A and B together to get the most coverage. For example, if you stay in a hospital, the stay would be covered under Medicare Part A and the doctor’s services would be covered under Part B.
Part B covers a wide range of tests and services, including:
- screening for cancer, depression, and diabetes
- ambulance and emergency department services
- influenza and hepatitis vaccinations
- medical equipment
- diabetes supplies
What does Medicare Part B cost?
Some of your Part B cost is a monthly premium of $148.50; however, your premium could be less or more or less depending on your income.
Some services are covered under Medicare Part B at no additional cost to you if you see a doctor that accepts Medicare. If you need a service outside of what is covered by Medicare, you will have to pay for that service yourself.
Medicare Part C, also called Medicare Advantage, is privately sold insurance options that include the same coverage as parts A and B in addition to extra benefits like prescription drug plans, dental, hearing, vision, and others. In order to purchase a Medicare Advantage plan, you must be enrolled in original Medicare.
What does Medicare Part C cost?
You usually pay a premium for these plans, and you have to see doctors within your network. Otherwise, copayments or other fees may apply. Your Medicare Part C cost depends on the type of plan you select.
Medicare Part D is the plan that covers prescription drugs not covered by Part B, which are typically the kind of medications that need to be administered by a doctor, like an infusion or injection. This plan is optional, but many people choose to have it so their medications are covered.
What does Medicare Part D cost?
The cost for Medicare Part D varies depending on what kinds of medications you take, the plan you have, and which pharmacy you choose. You will have a premium to pay and, depending on your income, you may have to pay additional costs. You may also have to make copayments or pay a deductible.
While Medicare covers a wide range of care, not everything is covered. Most dental care, eye exams, hearing aids, acupuncture, and any cosmetic surgeries are not covered by original Medicare.
Medicare does not cover long-term care. If you think you or a loved one will need long-term care, consider a separate long-term care insurance policy.
- Medicare is composed of five main types of coverage, Part A, Part B, Part C, Part D, and Medigap. These choices offer many options to meet your healthcare needs.
- While Medicare covers many healthcare services like hospitalization, doctor visits, and prescription drugs, there are medical services it does not.
- Medicare does not cover long term care, cosmetic procedures, and others. You can consult the Medicare coverage tool or call 800-MEDICARE to see if a specific service is covered.