Original Medicare is made up of 4 Parts, but at any given time you will only be using either Part A, Part B (if you have paid Part B Premium), and Part D OR you will be using Part C (also known as Medicare Advantage). Let me break down what each of these are below:
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some in home health care.
Most People do not pay for Part A as long as they have paid 40 quarters in the the Medicare system through taxes while they were working.
If you do need to use your Part A Medicare benefits, there is a large deductible that needs to be met before Part A starts paying hospital benefits, but then you will are covered for the 1st 60 days before you have to starting paying Part A copays and coinsurance.
Medicare Part B is outpatient medical coverage, or more easily thought of as doctor's office expenses. Part B helps pay for medically necessary services performed on an outpatient basis that are needed to diagnose and treat a medical condition.
Visits to your Primary Care Physician (PCP), Specialists, Surgeries, lab work, and preventative services are all covered under Medicare Part B. There is a monthly premium that you would be responsible for that will be withdrawn directly from your Social Security check if you are drawing Social Security. Otherwise you would need to pay the premium 3 months at a time from your checking account.
There is a once a year annual deductible that you would have to meet before Part B pays anything, then it is a 80/20 split where you would be responsible for 20% of the costs of service.
Medicare Part C is also called Medicare Advantage Plans (MA or MAPD). It’s an alternative to Original Medicare and actually replaces Original Medicare. Medicare Advantage Plans may include prescription drug coverage, along with other additional coverage that Medicare does not normally cover. These plans offered through private insurance companies, so you don’t enroll in it at the Social Security office or website. These are usually network plans such as HMO's and PPO's with copayments and coinsurance found throughout the plan based on the type of medical treatment you receive. If you have an MA plan then this becomes your Primary Insurance and Original Medicare gets set aside but you will still need to continue paying your Part B premiums.
Medicare Part D is your prescription drug coverage. Part D coverage is available as a Stand Alone Option (PDP) or as part of a Medicare Advantage plan (Part C). Part D plans are offered by private insurance companies contracted and it is mandatory that you have credible drug coverage when you join Original Medicare or if you choose a Medicare Advantage plan. Otherwise you will have a Part D Late Enrollment Penalty if you join a Part D Plan more than 63 days after you were first eligible for one.
To learn more about the options of having Original Medicare with a Supplement and Drug Plan OR choosing a Medicare Advantage plan, please click one of the buttons below. You can also always press the "Click to Call" button above to reach us today!
Get a Consultation
& Quote at No Cost