Understanding Medicare Parts A B C & D

Understanding the ABC's of Medicare CoverageUnderstanding All the Parts of Your Medicare Coverage

Medicare can certainly be confusing. To be sure you’re getting the most from your Medicare coverage, it’s important to understand all of Medicare’s parts, and what each one covers.

Who is Eligible for Medicare?

Even if you’re not 65 years old yet, or within three months of your 65th birthday, you may still be able to take advantage of Medicare. You may also qualify for Medicare Parts A and B if you are under 65 years old and have a disability, have ALS, get benefits from Social Security or the Railroad Retirement Board, or live in Puerto Rico and get benefits from Social Security or the RRB.
To determine if you’re eligible for Medicare, you can use the Medicare Eligibility Tool at Medicare.gov.

Understanding Medicare Parts A through D

Medicare is split into four parts, Medicare Parts A, B, C and D. Each part helps cover a specific set of health care services or expenses.
Medicare Part A-Medicare Part A is often referred to as hospital insurance. It helps cover expenses if you’re ever admitted to the hospital. However, Part A helps cover more than just hospital care. It also helps cover:

  • Inpatient care at a skilled nursing facility
  • Nursing home care
  • Home health services
  • Hospice care

Medicare Part B-This is medical insurance for medically necessary services and preventive services. Medicare Part B helps cover:

  • Getting a second opinion before surgery
  • Clinical research
  • Ambulance services
  • Limited outpatient prescription drugs
  • Durable medical equipment (including diabetes supplies)
  • Mental health services

Medicare Part C-Also known as Medicare Advantage, Medicare Part C refers to private health insurance plans that provide Medicare coverage. Medicare Advantage plans are required to provide the same benefits as Medicare Parts A and B except hospice care, and some plans offer even more benefits/services.
Medicare Advantage plans:

  • Must be approved by the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees the Medicare program
  • Carrier must maintain a contract with CMS to provide Medicare coverage
  • May offer prescription drug coverage (see Medicare Part D, below) as part of their plan offering
  • May offer additional services/programs, not offered by Medicare Parts A and B
  • May require you to use a specific network of doctors and hospitals
  • May require you to pay additional premiums, co-payments, coinsurance, deductibles or other out-of-pocket expenses, but offer a yearly limit on out-of-pocket costs.

Medicare Supplement Plans – They are also known as Medigap plans and they help pay for many of the out-of-pocket expenses (co-payments, coinsurance, deductibles, etc.) that Medicare Parts A and B cover but may not pay.  Private insurance companies offer Medigap plans, and there are currently 10 plans from which to choose. Keep in mind, however, that not all Medigap plans may be available where you live.

Understanding The ABC’s and D of Medicare

Medicare Part D– Medicare Part D is Medicare prescription drug coverage.  Medicare prescription drug plans:

  • Are plans that are provided by an insurance company or other private company approved by Medicare
  • Can be offered as stand-alone plans or as part of a Medicare Advantage plan
  • If you decide not to get Medicare prescription drug coverage when you’re first eligible, you may pay a late enrollment penalty

How Much Does it Cost?

Medicare Part A is premium-free for most people, as long as you are already receiving benefits from Social Security.  You pay a premium each month for Medicare Part B. If you get Social Security, Railroad Retirement Board, or Office of Personnel Management benefits, your Medicare Part B premium will be automatically deducted from your benefit payment. If you don’t get these benefit payments, you’ll get a bill. Most people pay the standard premium amount of $134 (for 2017), but it can be higher depending upon your income.

In addition, individuals with high incomes may need to pay more for their Medicare Part B premium. If you have limited income, you may qualify for a special Medicare savings program from your state.

Your Medicare Part B monthly premium will be higher if your modified adjusted gross income is more than $85,000 (single), or more than$170,000 (married and file a joint tax return) in 2017. These amounts may change each year. A few Medicare Advantage Plans may pay all or part of your Medicare Part B premium. You would still get all Medicare Part A and Part B-covered services except for hospice care. For more information about Medicare Part B premiums based on income, you can call Social Security toll free at 1-800-772-1213. TTY users can call 1-800-325-0778.  Benefits, premiums, and/or member cost-share may change on January 1 of each year. You must continue to pay your Medicare Part B premium.

Premiums for Medicare Advantage plans and Medigap plans, as well as Medicare Part D, prescription drug plans, vary based on your selected plan and insurance carrier. To find a plan in your area, you can use the Medicare Plan Finder at Medicare.gov, or contact a licensed sales insurance agent at Medicare Solutions by calling toll free at, 844-839-0813.

What are Late Enrollment Penalties?

If you don’t sign up for Medicare Part B and/or Part D as soon as you become eligible, you could wind up paying more in monthly premiums down the road. For Medicare Part B, if you don’t sign up when you’re first eligible, you’ll have to pay this late enrollment penalty for as long as you have Medicare Part B. Your premium each month could go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up. For Part D, Medicare multiplies 1% of the national base beneficiary premium, which is $35.63 in 2017 by the number of full, uncovered months you didn’t have Part D or creditable coverage. This premium is then rounded to the nearest $0.10 and added to your monthly Part D premium. The national base beneficiary premium may increase each year, so your penalty amount may also increase each year.

Still Have Questions?

If you’re eligible for Medicare, it’s important to make sure you’re getting all the coverage you deserve. Fortunately, understanding your options doesn’t have to be complicated. At MedicareSolutions.com, we’ve put together a number of informative articles on a variety of Medicare-related topics. You can also call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048 or visit Medicare.gov to learn more.