Parts of Medicare
There are four parts to Medicare, which include Part A, Part B, Part C, and Part D. Regardless of whether you are newly eligible for Medicare or already enrolled, it’s important to understand what is covered by each of these parts so you know how Medicare will benefit you personally.
Medicare Part A
Medicare Part A represents the hospital insurance portion of Medicare and provides coverage for inpatient care, skilled nursing, in-home care and hospice care. Long term nursing coverage is not covered under Medicare and can only purchase a policy through a private insurance company.
Original Medicare is very particular about who qualifies for skilled nursing home benefits. An individual must be admitted overnight in the hospital for a minimum of 3 days before Medicare will pay any portion of a skilled nursing home bill. If you are placed under observation for one or two days as many hospitals will designate your stay, this will not qualify for any part of the 3-day requirement.
Medicare Part B
Medicare Part B medical insurance provides coverage for outpatient care, behavioral health, medically necessary services, preventive services, diagnostic testing and lab services, durable medical equipment, and doctor administered drugs. Medicare Part B requires a monthly premium that is based on your income. As of 2021, CMS federal standard monthly premium charge is $148.50, however, premiums that Medicare charges will increase for higher income applicants. Social Security will collect one of 4 separate monthly premium charges based on individual or household income. Income used is Modified Adjusted Income and is an average of the last two years.
These increased adjustments from the standard premium are call Income Related Adjustment Charges
(see 2021 IRMAA at https://www.medicare.gov/Pubs/pdf/11579-Medicare-Costs.pdf).
Both Medicare Part A and B together are known as Original Medicare. Although coverage is provided for most hospital and medical services it should not be considered comprehensive coverage as there are large gaps in coverage with no annual stop loss limits. It would be wise for anyone going onto Medicare to meet with a Medicare agent to discuss options that will minimize liability and financial exposure.
Medicare Supplement plans and Medicare Advantage plans, although different in benefit structure both provide annual maximum out of pocket stop loss limits to their policyholders and members.
Medicare Part C
Medicare Part C plans, also known as Medicare Advantage plans, provide the same health services as Original Medicare insurance. The Medicare Advantage plans require their members to actively maintain their Original Medicare Part A and Part B status even though the Part C plan replaces Original Medicare. Members enrolled in the Part C plan are subject to the plan’s terms and conditions, copays, coinsurance, and deductibles if any.
Most Medicare Advantage plans will provide prescription drug coverage and extra benefits such as dental, vision, hearing coverage, fitness memberships, over the counter health products, food cards, transportation and more. Since these plans are offered by private companies that contract with Medicare, the costs for these plans will vary. Many of these plans have a zero Medicare plan premium or low premium costs. However, you will still be required to pay your monthly Part B premium charged by Medicare.
Medicare Part D
Medicare Part D is the prescription drug coverage plan. Each Part D plan must cover two drugs from every category and class, but these specific drugs will vary by plan. The costs for these plans will also vary.
You can add this plan to your Original Medicare coverage, or you can get it as an additional benefit with a Medicare Advantage plan.
Get Medicare Today—Call Iowa Medicare Group
At Iowa Medicare Group, we understand the importance of understanding your coverage options. That’s why we specialize in providing seniors with the insurance solutions they need. To learn more about the different parts of Medicare and what each can do for you, give us a call today.