Understanding Medicare Parts A B C & D

Understanding All the Parts of Your Medicare Coverage

Understanding 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 importation 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 or within three months of your 65th birthday, you may qualify for Medicare Parts A and B if you have a disability, have ALS, get benefits from Social Security or the Railroad Retirement Board (RRB), or live in Puerto Rico and get benefits from Social Security or the RRB.

To determine whether you are eligible for Medicare, use the Medicare Eligibility Tool.

Understanding Medicare Parts A through D

Medicare is split into four parts: A, B, C, and D. Each part helps cover a specific set of healthcare services or expenses.

Medicare Part A

Medicare Part A is often referred to as hospital insurance. It helps cover expenses whenever you’re admitted to a hospital as well as:

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

Medicare Part B

Medicare Part B is often referred to as medical insurance and it covers medically-necessary care and preventive services. This includes:

  • 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

Medicare Part C is also known as Medicare Advantage; it refers to private health insurance plans that provide Medicare coverage. Medicare Advantage (MA) plans are required to provide the same benefits as Medicare Parts A and B (except hospice care, which is provided by Part A even if you have Medicare Advantage). Some MA plans offer additional benefits and services. Medicare Advantage plan features include:

  • 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 require you to use a specific network of doctors and hospitals
  • May require you to pay additional premiums, co-payments, co-insurance, deductibles, or other out-of-pocket expenses, but offer a yearly limit on out-of-pocket costs

Medicare Part D

Medicare Part D is Medicare Prescription Drug Coverage. These plans:

  • 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
  • Carry a late enrollment penalty if you do not sign up for Medicare Prescription Drug Coverage when you first become eligible and go more than 63 days without creditable coverage

How Much Does it Cost?

Costs for Medicare Parts C and D vary according to the plan you choose. Parts A and B costs may change yearly.

Medicare Part A Costs

Medicare Part A is premium-free for most people. If you or your spouse worked and paid Medicare taxes for at least 10 years, you earned the 40 credits necessary for premium-free Part A.

One credit equals three months of paying Medicare taxes. If you have between 30 and 39 credits, your monthly premium is $232. If you have fewer than 30 credits, your premium is $422 per month.

Your deductible each benefit period is $1,340. Co-insurance is $0 for days 1-60, $335 for days 61-90, and $670 for days 91 and beyond.

Medicare Part B Costs

Part B carries a monthly premium, even if you have Medicare Advantage. For most people, this is $134. If your individual income is over $85,000, or $170,000 for married filing jointly, your monthly premium ranges between $187.50 and $428.60, depending on your income.

All Part B beneficiaries have a yearly deductible of $183. Once you meet your deductible, your co-payment is 20 percent of the Medicare-approved amount for most doctor services.

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 Medicare Solutions, we’ve created a library of resources on a variety of Medicare-related topics, as well as comprehensive blog. You can also call us toll-free at 1-844-655-4647 (TTY 711) to speak to a licensed agent.