Medicare Part A: Hospital Coverage (Inpatient)
Hospital Inpatient Care
Skilled Nursing Facility/Rehab and Recovery Care
Home Health Care
Part A is free if you have worked the required time, generally ten years or 40 quarters, and paid Medicare taxes while working.
Medicare Part B: Medical Insurance (Outpatient)
Part B of Medicare provides Outpatient medical services. You can receive these outpatient medical services and treatments at a doctor’s office, hospital, or clinic. There is an annual deductible of $233 for Part B medical services, and after the deductible is met, Medicare only covers 80% of Part B medical expenses. The following is a list of outpatient medical services and treatments that require 20% coinsurance.
- Doctor office visits
- Diagnostic testing and Lab tests
- Outpatient surgery
- Radiation and Chemotherapy treatments
- Kidney dialysis
- Physical, speech, and occupational therapy
- Durable medical equipment
- Drugs administered in a doctor’s office
- Mental health services
- Ambulance services
- Emergency Room
Enrolling in a Medicare Supplement will cover the 20% coinsurance.
You pay a monthly premium to the government for your Part B coverage. The standard Part B premium for 2022 is $170.10. If your income exceeds a certain amount, your premium could be higher than the standard premium.
Medicare Part C: Medicare Managed Care Plans
Part C of Medicare refers to Medicare Advantage Plans (MA Plans). Private insurance companies approved by the Center for Medicare and Medicaid Services offer MA plans. Medicare Advantage Plans are not considered supplemental Medicare coverage. Advantage Plans must provide the same benefits as Original Medicare (those covered under Parts A and B); however, each plan can charge different out-of-pocket costs and have different rules for getting services. They can require pre-authorization for medical care, referral before seeing a specialist, and go to doctors and hospitals in their network. You pay considerably more if you want to see doctors outside the network. If you enroll in an Advantage Plan, you must continue to pay the Medicare Part B premium of $170.10.
Medicare Part D: Prescription Drug Coverage
Part D of Medicare is the prescription drug benefit that covers outpatient prescription drugs. Part D is offered by private companies that have contracts with the government to provide this coverage. You pay a monthly premium to an insurance company for your Part D plan. You will have an annual deductible to meet and have to pay a copay or a percentage of the drug’s cost. Each Medicare prescription drug plan has a list of covered drugs, called its formulary.
Medicare drug plans place medications in their formulary that are placed in Tiers 1-5. The lower the tier, the less you pay for the medication. Brand name medications that are not available in generic can be expensive with a Medicare drug plan. It would be best to enroll in a Part D prescription drug plan when you first go on Medicare or lose your employer coverage. If you delay enrollment, you will have to pay a late enrollment penalty and have gaps in your coverage.