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Medicare
Basics

Parts of Medicare

Part A

Hospital
Insurance

Part B

Medical
Insurance

Medicare Coverage Choices

When you first sign up for Medicare and during certain times of the year, you can choose how you get your Medicare coverage.

  • Original Medicare (Part A and Part B)
  • or Medicare Advantage Plan (Part C)

Some people need to get additional coverage, like Medicare drug coverage or Medicare Supplement Insurance (Medigap). 

Original Medicare (also known as PART A & B)

  • Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
  • You can join a separate Medicare drug plan to get Medicare drug coverage (Part D).
  • You can use any doctor or hospital that takes Medicare, anywhere in the U.S.
  • To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also shop for and buy supplemental coverage.

FACT: If you don’t get Medicare Part B or Medicare Part D when you’re first eligible, you may have to pay more to get this coverage later. This could mean you’ll have a lifetime premium penalty for your Medicare Part B and Prescription drug coverage.

Medicare Advantage (also known as PART C)

  • Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.
  • In most cases, you’ll need to use doctors who are in the plan’s network.
  • Plans may have lower out-of-pocket costs than Original Medicare.
  • Plans may offer some extra benefits that Original Medicare doesn’t cover—like vision, hearing, and dental services.

In General

PART A Covers:

  • Inpatient care in a hospital
  • Skilled nursing facility care
  • Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care)
  • Hospice care
  • Home health care

A

In General

PART B Covers:

  • Services from doctors and other health care providers
  • Ambulance services
  • Outpatient care
  • Home health care
  • Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
  • Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)
  • Mental health
    • Inpatient
    • Outpatient
    • Partial hospitalization
    • Intensive outpatient program services (starting January 1, 2024)

B

In General

PART C Covers:

You get all the benefits of Original Medicare plus “extras” Medicare does not cover. Plans may offer benefits for dental, vision, hearing, acupuncture, over-the-counter items and more.

C

In General

PART D Covers:

Part D helps cover the cost of prescription drugs (including many recommended shots or vaccines). You join a Medicare drug plan in addition to Original Medicare, or you get it by joining a Medicare Advantage Plan with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare. The types of drugs covered and the pharmacies you can use vary by plan.

D

Two ways to find out if Medicare covers what you need

  1. Talk to your doctor or other health care provider about why you need certain services or supplies. Ask if Medicare will cover them. You may need something that’s usually covered but your provider thinks that Medicare won’t cover it in your situation. If so, you’ll have to read and sign a notice. The notice says that you may have to pay for the item, service, or supply.
  2. Find out if Medicare covers your item, service, or supply.

Medicare coverage is based on three factors

  1. Federal and state laws.
  2. National coverage decisions made by Medicare about whether something is covered.
  3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area

NEW INSULIN BENEFIT! If you use an insulin pump that’s covered under Part B’s durable medical equipment benefit, or you get your covered insulin through a Medicare Advantage Plan, your cost for a month’s supply of Part B-covered insulin for your pump can’t be more than $35. The Part B deductible won’t apply. If you get a 3-month supply of Part B-covered insulin, your costs can’t be more than $35 for each month’s supply. This means you’ll generally pay no more than $105 for a 3-month supply of covered insulin. If you have Part B and Medicare Supplement Insurance (Medigap) that pays your Part B coinsurance, you plan should cover the $35 (or less) cost for insulin.

Have additional questions?

Medicare can be confusing. If you have questions, contact me.

Medicare
Basics

Parts of Medicare

Part A

Hospital
Insurance

Part B

Medical
Insurance

Medicare Coverage Choices

When you first sign up for Medicare and during certain times of the year, you can choose how you get your Medicare coverage.

  • Original Medicare (Part A and Part B)
  • or Medicare Advantage Plan (Part C)

Some people need to get additional coverage, like Medicare drug coverage or Medicare Supplement Insurance (Medigap). 

Original Medicare (also known as PART A & B)

  • Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
  • You can join a separate Medicare drug plan to get Medicare drug coverage (Part D).
  • You can use any doctor or hospital that takes Medicare, anywhere in the U.S.
  • To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also shop for and buy supplemental coverage.

Medicare Advantage (also known as PART C)

  • Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.
  • In most cases, you’ll need to use doctors who are in the plan’s network.
  • Plans may have lower out-of-pocket costs than Original Medicare.
  • Plans may offer some extra benefits that Original Medicare doesn’t cover—like vision, hearing, and dental services.

In General

PART A Covers:

  • Inpatient care in a hospital
  • Skilled nursing facility care
  • Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care)
  • Hospice care
  • Home health care

A

In General

PART B Covers:

  • Services from doctors and other health care providers
  • Ambulance services
  • Outpatient care
  • Home health care
  • Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
  • Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)
  • Mental health
    • Inpatient
    • Outpatient
    • Partial hospitalization
    • Intensive outpatient program services (starting Jan 1, 2024)

B

In General

PART C Covers:

You get all the benefits of Original Medicare plus “extras” Medicare does not cover. Plans may offer benefits for dental, vision, hearing, acupuncture, over-the-counter items and more.

C

In General

PART D Covers:

Part D helps cover the cost of prescription drugs (including many recommended shots or vaccines). You join a Medicare drug plan in addition to Original Medicare, or you get it by joining a Medicare Advantage Plan with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare. The types of drugs covered and the pharmacies you can use vary by plan.

D

Two ways to find out if Medicare covers what you need

  1. Talk to your doctor or other health care provider about why you need certain services or supplies. Ask if Medicare will cover them. You may need something that’s usually covered but your provider thinks that Medicare won’t cover it in your situation. If so, you’ll have to read and sign a notice. The notice says that you may have to pay for the item, service, or supply.
  2. Find out if Medicare covers your item, service, or supply.

Medicare coverage is based on three factors

  1. Federal and state laws.
  2. National coverage decisions made by Medicare about whether something is covered.
  3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area

NEW INSULIN BENEFIT! If you use an insulin pump that’s covered under Part B’s durable medical equipment benefit, or you get your covered insulin through a Medicare Advantage Plan, your cost for a month’s supply of Part B-covered insulin for your pump can’t be more than $35. The Part B deductible won’t apply. If you get a 3-month supply of Part B-covered insulin, your costs can’t be more than $35 for each month’s supply. This means you’ll generally pay no more than $105 for a 3-month supply of covered insulin. If you have Part B and Medicare Supplement Insurance (Medigap) that pays your Part B coinsurance, you plan should cover the $35 (or less) cost for insulin.

FACT: If you don’t get Medicare Part B or Medicare Part D when you’re first eligible, you may have to pay more to get this coverage later. This could mean you’ll have a lifetime premium penalty for your Medicare Part B and Prescription drug coverage.

Have additional questions?

Medicare can be confusing. If you have questions, contact me.

Medicare
Basics

Parts of Medicare

Part A

Hospital
Insurance

Part B

Medical
Insurance

Part C

Medicare
Advantage

Part D

Prescription Drug Coverage

Medicare Coverage Choices

When you first sign up for Medicare and during certain times of the year, you can choose how you get your Medicare coverage.

  • Original Medicare (Part A and Part B)
  • or Medicare Advantage Plan (Part C)

Some people need to get additional coverage, like Medicare drug coverage or Medicare Supplement Insurance (Medigap). 

Original Medicare
(also known as PART A & B)

  • Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
  • You can join a separate Medicare drug plan to get Medicare drug coverage (Part D).
  • You can use any doctor or hospital that takes Medicare, anywhere in the U.S.
  • To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also shop for and buy supplemental coverage.

FACT: If you don’t get Medicare Part B or Medicare Part D when you’re first eligible, you may have to pay more to get this coverage later. This could mean you’ll have a lifetime premium penalty for your Medicare Part B and Prescription drug coverage.

Medicare Advantage
(also known as PART C)

  • Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.
  • In most cases, you’ll need to use doctors who are in the plan’s network.
  • Plans may have lower out-of-pocket costs than Original Medicare.
  • Plans may offer some extra benefits that Original Medicare doesn’t cover—like vision, hearing, and dental services.

In General

PART A Covers:

  • Inpatient care in a hospital
  • Skilled nursing facility care
  • Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care)
  • Hospice care
  • Home health care

A

In General

PART B Covers:

  • Services from doctors and other health care providers
  • Ambulance services
  • Outpatient care
  • Home health care
  • Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
  • Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)
  • Mental health
    • Inpatient
    • Outpatient
    • Partial hospitalization
    • Intensive outpatient program services (starting Jan 1, 2024)

B

In General

PART C Covers:

You get all the benefits of Original Medicare plus “extras” Medicare does not cover. Plans may offer benefits for dental, vision, hearing, acupuncture, over-the-counter items and more.

C

In General

PART D Covers:

Part D helps cover the cost of prescription drugs (including many recommended shots or vaccines). You join a Medicare drug plan in addition to Original Medicare, or you get it by joining a Medicare Advantage Plan with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare. The types of drugs covered and the pharmacies you can use vary by plan.

D

Two ways to find out if Medicare covers what you need

  1. Talk to your doctor or other health care provider about why you need certain services or supplies. Ask if Medicare will cover them. You may need something that’s usually covered but your provider thinks that Medicare won’t cover it in your situation. If so, you’ll have to read and sign a notice. The notice says that you may have to pay for the item, service, or supply.
  2. Find out if Medicare covers your item, service, or supply.

Medicare coverage is based on three factors

  1. Federal and state laws.
  2. National coverage decisions made by Medicare about whether something is covered.
  3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area

NEW INSULIN BENEFIT! If you use an insulin pump that’s covered under Part B’s durable medical equipment benefit, or you get your covered insulin through a Medicare Advantage Plan, your cost for a month’s supply of Part B-covered insulin for your pump can’t be more than $35. The Part B deductible won’t apply. If you get a 3-month supply of Part B-covered insulin, your costs can’t be more than $35 for each month’s supply. This means you’ll generally pay no more than $105 for a 3-month supply of covered insulin. If you have Part B and Medicare Supplement Insurance (Medigap) that pays your Part B coinsurance, you plan should cover the $35 (or less) cost for insulin.

Have additional questions?

Medicare can be confusing. If you have questions, contact me.