Medicare is complicated, especially if you are a new enrollee. It’s important to understand the benefits you can receive to decide which plan is best for you, whether it be prescription drug coverage, an Advantage plan, or additional coverage through Medigap. Read on to learn Everything You Should Know About the Different Parts of Medicare.
Part A
In general, Medicare Part A covers inpatient care in a hospital, skilled nursing facility care, hospice care, and home health care. Part A premium is free for those who paid Medicare payroll taxes for at least 40 quarters, but the standard Part A premium cost varies if you paid Medicare taxes for fewer quarters.
For example, Part A premium costs $471 if you paid Medicare taxes for less than 30 quarters and $259 if you paid taxes for 30-39 quarters. As for hospital inpatient deductible and coinsurance, a $1,484 deductible applies for hospital stays that exceed 60 days for 2021.
Part B
Medicare Part B covers two types of services: Medically necessary services and preventative services. Some specific things it covers include clinical research, outpatient and inpatient mental health care, ambulance services, and durable medical equipment. The 2021 deductible is $203, and the base premium is $148.50 per month.
Once you hit the deductible, you pay 20% of expenses unless you have Medicare Advantage or supplemental coverage. If you fail to enroll at age 65, you’ll have to pay a permanent 10% of the monthly premium multiplied by the number of years after age 65 in which you didn’t enroll.
Part C
Also known as Medicare Advantage, Medicare Part C covers Parts A and B beneficiaries through private insurers rather than traditional government-administered Medicare companies. The majority of Advantage plans include prescription drug coverage. The monthly premium costs vary depending on plans, but the average monthly premium is $21. You can compare costs on Medicare.gov.
Part D
Medicare Part D covers prescription drugs through private insurers. You only will need Part D if you have Original Medicare and want medications covered. If you opt for a Medigap plan or Advantage plan that includes prescription drugs, there is no need for Part D.
Suppose you decide to get Part D after your initial enrollment period; in that case, you’ll pay 1% of the base premium multiplied by the number of months you went without it. Currently, the base premium is about $33 per month.
Medigap
Medical Supplement Insurance, also known as Medigap, is private insurance that fills the gaps of Original Medicare coverage. Medigap plans cover part or most of Part A and B’s remaining health care costs, such as copayments, coinsurance, and deductibles.
Medigap plans are different than Advantage plans in multiple ways. First, they have higher monthly premiums than Advantage plans but lower out-of-pocket expenses. Additionally, advantage plans are to get Medicare benefits, while Medigap policies simply supplement your Original Medicare benefits.