If you’re interested in signing up for Medicare and begin to do research, you’ll likely encounter the following terms: Part A, Part B, Part C, and Part D. Each of the parts of Medicare cover different services, so before you sign up, you’ll need to understand your options.
When you’re eligible and ready to sign up for Medicare, it’s important to know exactly what you’re signing up for. To help get you started, we’ve put together this quick guide that explains the ABCs of Medicare.
Medicare Part A
Medicare Part A is also known as hospital insurance, and together with Part B, forms Original Medicare. Most people don’t have to pay a premium for Part A. However, some people don’t qualify for premium free part A. Those who don’t qualify may opt to sign up for Part A, but they will have to pay a monthly premium.
Medicare Part A covers these services:
- Inpatient hospital care
- Skilled nursing facility care
- Home health care
- Hospice care
Medicare Part B
Medicare Part B (medical coverage) covers a long list of medical services, such as outpatient services, doctor visits, x-rays, lab tests, and preventive screenings. Though you’re not required to enroll in Part B, if you miss your Initial Enrollment Period (IEP), you’ll be penalized if you sign up later unless you qualify for a Special Enrollment Period (SEP).
Here is a list of services covered by Medicare Part B:
- Provider services
- Home health service
- Ambulance services
- Therapy services
- Mental health services
- Chiropractic care
- X-rays and lab tests
- Durable medical equipment (DME)
- Select prescription drugs
- Remember that Original Medicare may not pay for the total cost of care, and you’ll likely be responsible for deductibles, coinsurance, and/or copayments.
Medicare Part C
Medicare Part C, also known as Medicare Advantage, is offered by private insurance companies contracted with Medicare. These plans provide coverage for both hospital and medical insurance, and many include Part D (drug coverage). At a minimum, all Medicare Advantage plans must offer the same level of coverage as Original Medicare. Medicare Advantage plans may also cover additional benefits not included in Original Medicare, such as vision, dental, and prescriptions. When signing up for a Medicare Advantage plan, you will need to continue to pay your monthly Part B premium.
If you enroll in a Medicare Advantage plan, you must use the plan’s network of providers to get care. Be sure to assess the quality and size of a plan’s network and see if your current providers will be in-network. You will be responsible for the charges if you get out-of-network care.
It’s also important to check if Part D benefits are included in the Medicare Advantage plan you are interested in. You’ll need to buy a Part D plan for coverage if these benefits aren’t included. If you’re considering a Medicare Advantage plan with prescription coverage, check to see if the plan covers the medications you take and if your pharmacy is in the network.
Medicare Part D
Part D, also known as drug coverage, helps cover the cost of prescription drugs, shots, and/or vaccines. Much like with Part B, if you don’t sign up during your IEP, you’ll likely face late enrollment penalties unless you qualify for an SEP. All Part D plans must include at least two drugs from most categories and must cover all drugs available in the following categories:
- Antidepressants
- Antipsychotic medications
- Immunosuppressant drugs
- HIV/AIDS treatment
- Anticancer drugs
Medigap
Medicare Supplement Insurance plans, also known as Medigap, are like Medicare Advantage plans. They provide coverage for many costs not covered by Original Medicare. One main difference is Medicare Supplement plans do not usually include Medicare Part D, so if you choose to go with this option, you will also need a prescription drug plan.
Key Takeaways
Every person’s medical and financial situation is different, and there are a lot of factors you should consider when deciding which Medicare option is best for you. Connect with The Baldwin Group team today for an assessment of your situation and advice that will empower you to make an informed decision.
