The A, B, C and D’s of Medicare
Part A coverage is automatic on the first day of the month in which you turn 65 or earlier under certain circumstances, is premium-free for most and provided by the Federal Government. Part A helps pay for inpatient hospital stays and services associated with inpatient stays. There is an annual deductible with Part A and then per-day copayments for the inpatient stays.
Part B coverage is elective and has a monthly premium. Part B helps pay for doctor visits and other medical services. Part B has a small calendar year deductible and then generally pays 80% of the eligible approved charges. There is no maximum out-of-pocket cost to an individual. It is very important to know when to elect Part B as there are ramifications for electing it too soon or too late.
Part C represents the contracts that can be purchased through private insurance carriers that either replace Medicare or supplement Medicare.
- The Medicare Advantage plans replace Medicare – you continue to pay the Part B premium, but all claims are submitted through the private insurance carrier and coverage works similarly to non-Medicare health
Plans, like a traditional HMO plan with specific provider networks, deductibles, coinsurance, copays, etc.
- Medicare Supplements do just that – they supplement Medicare. So if Medicare considers the claim eligible and approves, the amount not covered by Medicare is paid by the supplement purchased. There are no provider networks on supplement policies, therefore, they provide the most freedom but do have a higher cost than Medicare Advantage plans.
Part D Plans are the prescription drug component. Some Medicare Advantage plans include a prescription drug benefit but none of the Medicare Supplement plans have drug coverage. An evaluation of the individual’s specific drugs is essential to providing the best plan as each carrier in this market has their own formulary list of preferred drugs and pharmacies.
Medicare does not pay for every health care cost an individual incurs. There are penalties and time frames to when an individual can elect Part B, C and D plans. Please call us to book an appointment to discuss your options.