Medicare is a public health insurance program for people 65 years or older, certain younger people with disabilities, and their families. Medicare provides access to medical care for more than 40 million Americans and covers over one-third of the U.S. economy annually. The program is divided into four parts:
- Medicare Part A (provides inpatient/hospital coverage).
- Medicare Part B (which provides outpatient/medical coverage).
- Medicare Part C (which serves as an alternate method to receive Medicare benefits ).
- Medicare Part D (offers prescription drug coverage).
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Use Medicare Plan Finder
The Medicare Plan Finder is an online tool on the Medicare.gov site that allows users to compare any Medicare plan options, including Medicare Part C plan, Medicare Part D plans, and Medigap supplemental policies.
Medicare Part A
Medicare Part A (Hospital Insurance) is a primary insurance plan covering several medical services associated with skilled nursing care and inpatient hospitalization. This is provided at low or zero costs to Americans who have attained 65 years and have been contributing to Social Security and other qualified state or local employment-related pension plans for 40 quarters.
What Medicare Part A Covers
• Inpatient care in a hospital – Most Medicare beneficiaries entitled to skilled nursing care in a hospital are enrolled in Medicare Part A (Hospital Insurance). This program will provide limited coverage for individuals who have been diagnosed with a certain illness or injury. Medicare Part A (Hospital Insurance) covers inpatient care: Non-hospital based care, emergency care, and intensive Skilled Nursing Facility (SNF) care.
• Skilled nursing care in a health facility includes the combination of personal care and certain skilled nursing services, including independent living or living-alone services. It also includes nursing care in the home. It is an optional benefit for qualified individuals who have already received their initial 3-day hospital stay.
• Inpatient care in a skilled nursing facility – This is a care program for individuals who delay developing their capacity for self-management, need additional assistance in their daily living, and cannot do so safely at home. Skilled nursing care is needed in these situations. The most common benefits covered under Medicare Part A (Hospital Insurance) include skilled nursing facility services.
• Hospice care is a specific type of in-home health care provided to enhance the quality of life for people dying from a life-threatening illness or disease. Hospice encompasses services that vary from utility-based home health services to intensive care at home, and compassionate care.
• Home health care – Home health care provides physical, social, and psychological services. These services can be provided in various settings such as the home, in-home respite care, home healthcare aides, and emergency room visits. Medicare Part A (Hospital Insurance) is an optional benefit for qualified individuals who have already received their initial 3-day hospital stay and have been hospitalized for at least 24 hours during the same hospitalization.
Cost of Medicare Part A
If you or your spouse has been working for a minimum of 40 calendar quarters in any profession that pays Social Security taxes, you are not required to pay any Part A premiums.
The 2022 deductible is $1556 for every benefit period as of the year.
Those who do not qualify for Part A zero premiums are required to pay a premium of either $499 or $274, depending on the period worked and paid the Medicare taxes.
Medicare Part A Enrollment
An individual is eligible for this part at the age of 65. If individuals work for 40 calendar quarters, they are eligible for Part A on their 65th birthday.
Medicare Part B
Also referred to as medical insurance consists of an insurance plan covering medical services associated with outpatient and doctor’s care. This part takes care of medically necessary care and treatment, including:
- Medically necessary services include diagnostic tests, prescription drugs, eyeglasses, prostheses, and durable medical equipment (DME).
- Preventive services include recommended screenings, vaccination, and tuberculosis (TB) treatment.
- Clinical research, including laboratory tests, imaging, and prescription drugs.
- Prosthetic devices such as artificial limbs, dentures, and hearing aids.
- Ambulance services, including emergency medical transportation services.
- Mental health services such as psychotherapy and substance abuse testing.
- Hearing services, including hearing aids, wheelchairs, and dentures.
- Limited outpatient medications which a medical practitioner prescribes.
- Prescription drugs are deemed medically necessary by a physician and dispensed by the pharmacies.
Cost of Medicare Part B
Medicare Part B standard costs in 2022 are:
- A premium of $170.10 per month (or higher depending on your income)
- A deductible of $233
- Coinsurance of 20%
Medicare Part B Enrollment Period
An individual is eligible for enrollment in this part in the first seven months of the 65th birthday, starting three months before the 65th birthday month. This is referred to as the Initial Enrollment Period (IEP). However, this enrollment is automatic if you receive Railroad Retirement Board benefits or Social Security.
Medicare Part C
Also referred to as Medicare Advantage consists of coverage benefits of Medicare Parts A & B. Part C plan also provides prescription drug benefits among other coverages such as dental and vision. Other things Medicare Part C covers include:
- Vision – Free yearly eye exams for people over 60 and older.
- A dental-free preventive dental check-up every six months for seniors to prevent decay in the teeth.
- Hearing – Free hearing screening.
- Mental Health – Free initial diagnostic test for a new mental or behavioral condition or when a person is told they have a mental illness.
- Health and wellness programs – free counseling and wellness programs.
Cost of Medicare Part C
As of 2022, the Medicare Part C premium’s estimated mean is $19 every month. Most of the beneficiaries of Medicare Part C are not required to pay monthly premiums for their plans apart from the premium of Medicare Part B. Costs differ between plans.
Medicare Part C Enrollment Period
An individual is eligible for enrolment in this part during their IEP(Initial Enrollment Period). It occurs in the seven months before their 65th birthday. Their IEP starts three months before their 65th birthday. Enrolment is optional instead of automatic since an individual must have Medical Parts A & B before signing up for Part C.
Medicare Part D
This part covers prescription drug coverage as a standalone policy. This coverage only covers the specified brand-name medications, not the generic ones, unless the Commissioner has approved an exception for Social Security.
Cost of Medicare Part D
- As of 2022, the average premium for Medicare Part D is $33 monthly.
- Deductibles are between $0 – $480.3
Medicare Part D Enrollment Period
Like part C, an individual is eligible for enrolment in this part during their IEP(initial enrollment period), which is three months before the last month of their 65th birthday.