Medicare
Medicare can be confusing. We developed this page in order to provide foundational information about the basic parts of Medicare.
What is Medicare?
Medicare is the federal government health insurance program that provides coverage for people 65 year old or under; under 65 years old and have Social Security Disability Insurance (SSDI) for a certain duration of time, or under age 65 and have End-Stage Renal Disease.
What are the parts of Medicare?
Medicare is broken into 4 parts. Parts A, B, C, and D. Each of these parts will provide health insurance coverage in a unique way.
Medicare Part A
Part A is your Hospital Insurance that helps cover some of your health care costs.
What does Part A cover?
1. Your inpatient care in a hospital.
2. Your care in a skilled nursing facility.
3. Hospice care.
4. Home health care.
Part A Benefits
The following is a breakdown of your Medicare Part A benefits. It shows you what Medicare pays. You are responsible for the remaining costs unless you have a Medicare Supplement plan to cover these expenses.
Hospitalization*
Skilled Nursing Facility Care*
- Services Medicare Pays
- First 20 days All approved amounts
- 21st through 100th day All but $176 a day
- 101st day & after $0
Blood
- Services Medicare Pays
- First 3 pints $0
- Additional amounts 100%
Hospice Care
- Services Medicare Pays
Medicare Part B
Part B is your Medical Insurance that helps cover some of your costs.
What does Part B cover?
1. Doctor and related health care provider services.
2. Outpatient care.
3. Home health care.
4. Durable Medical Equipment.
5. Some health preventative services.
Part B Benefits
The following is a breakdown of your Medicare Part B benefits. It shows you what Medicare pays. You are responsible for the remaining costs unless you have a Medicare Supplement plan to cover these expenses.
Medical Expenses
- Services Medicare Pays
- 1st $198 of approved amounts $0
- Remainder of approved amounts Generally 80%
- Part B Excess Charge $0
Blood
- Services Medicare Pays
- First 3 pints $0
- Next $198 of approved amounts $0
- Remainder of approved amounts Generally 80%
Clinical Laboratory Services
- Services Medicare Pays
- Tests for diagnostic services 100%
Foreign Travel
- Services Medicare Pays
- First $250 during 1st 60 days $0
- Remainder of charges up to a a lifetime max of $50,000 $0
Parts A and B Benefits
Both Part A and Part B benefits help cover the costs of home health care – Medicare approved services.
Below is a breakdown of benefits. It shows you what Medicare pays. You are responsible for the remaining costs unless you have a Medicare Supplement plan to cover these expenses.
Home Health Care
Medicare Part C
Part C is also known as Medicare Advantage (MA) or (MAPD).
What does Part C cover?
1. Your Part A & B coverage is now managed and run by a Medicare approved insurance company and not original Medicare.
2. You are not automatically placed in a Part C (Medicare Advantage) plan. It is a choice to be made by you to join a Part C or Medicare Advantage plan.
3. Typically includes Part D (Medicare prescription drug coverage) as part of the plan. This is known as MAPD (Medicare Advantage with Part D).
Medicare Part D
Part D is your coverage for Medicare prescription drugs.
What does Part D cover?
1. Part D is managed and run by private insurance companies that are approved by Medicare.
2. You are not automatically placed into a Part D plan. Just like Part C, it is a choice to join a Part D plan.
3. Part D plans are designed to help cover prescription drug costs.
4. The Part D plan may help protect against increasing drug costs in the future and lower your prescription drug costs.
What about Medicare Supplements?
Medicare pays roughly 80% of your Part A and Part B medical costs and you’re responsible for the remaining 20%.
Medicare supplement insurance plans are there to help cover that 20%. Medicare supplements have nothing to do with Part C (Medicare Advantage) or Part D.
You will want to get a Part D drug plan if you choose to purchase a Medicare Supplement to help with drug costs.
Please remember that when you become eligible for Medicare, you can opt for either a Medicare Supplement or a Medicare Advantage plan (Part C).
You are not allowed to have both.
