Understanding Medicare can be very confusing. We have done our best to simplify Medicare by explaining the basics: what is Medicare health insurance, what does Part A, Part B and Part D mean, what is covered and not covered, how do I save money and pay for prescription drugs and how do other types of insurance fit in. Click on the questions below to be taken to each answer. Simply click back to the top to be taken to the various questions again.
- Who runs the Medicare Program?
- What is Medicare?
- What is Medicare Part A?
- What is Medicare Part B?
- What isn’t covered by Medicare Part A and B?
- What is Medicare prescription drug coverage?
- What are my Medicare healthcare choices?
- When can I make changes to my coverage?
- Can I have other types of health insurance?
- How can I get help to pay healthcare and prescription costs?
- Where can I get more information?
Who runs the Medicare Program?
- The Centers for Medicare & Medicaid Services (CMS) is the Federal agency that runs Medicare.
- CMS is part of the U.S. Department of Health and Human Services.
What is Medicare?
Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant). Medicare has the following parts:
• Part A (Covers Hospitalization)
• Part B (Medical Insurance, covers testing and doctor visits)
• Part C (Medicare Advantage Plans, like an HMO or PPO)
• Part D (Medicare prescription drug coverage)
For More information check out Medicare and You
What is Medicare Part A?
- Medicare Part A helps cover inpatient care in hospitals. This includes critical access hospitals and inpatient rehabilitation facilities.
- It also helps cover hospice care and home health care, and skilled nursing facilities (not custodial or long-term care). You must meet certain conditions to get these benefits.
- Medicare Part A has a deductible you must pay for each period of care. In 2023, the deductible is $1,600.
- Medicare Part A Cost: You usually don’t pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working.
What is Medicare Part B?
- Medicare Part B helps cover medically-necessary services like doctors’ services, outpatient care and other medical services.
- Part B also covers some preventive services. These include a one-time “Welcome to Medicare” physical exam, bone mass measurements, flu and pneumococcal shots, cardiovascular screenings, cancer screenings, diabetes screenings, and more.
- Medicare Part B has a deductible of $226/year. Upon meeting your deductible, Medicare Part B covers only 80% of these services.
- Medicare Part B Cost: Most people pay the standard Part B premium ($164.90 in 2023) each month.
- Some people may pay a higher premium based on their income. Your monthly premium will be higher than the standard premium if you are single (file an individual tax return), and your yearly modified adjusted gross income is more than $97,000 (in 2023), or if you are married (file a joint tax return) and your yearly modified adjusted gross income is more than $194,000 (in 2023).
What isn't covered by Medicare Part A & Part B?
- Medicare doesn’t cover everything.
- For example, Medicare doesn’t cover cosmetic surgery, health care you get while traveling outside of the United States (except in limited cases), hearing aids, most hearing exams, long-term care (like care in a nursing home), most eyeglasses, most dental care and dentures and more.
- In our experience, most care and services received from your doctor, like routine office visits, MRIs, surgery and hospital stays are approved by Medicare A and B.
What is Medicare prescription drug coverage?
- Medicare offers prescription drug coverage (Part D) for everyone with Medicare. This coverage may help you lower your prescription drug costs and help you protect against higher costs in the future. It can give you greater access to drugs that you can use to prevent complications of diseases and stay well.
- To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare.
- Medicare Part D Cost: Each plan can vary in cost and drugs covered.
- If you join a Medicare drug plan, you usually pay a monthly premium.
- If you decide not to join a Medicare drug plan when you are first eligible, you may pay a penalty if you choose to join later.
- If you have limited income and resources, you might qualify for extra help paying your Part D costs.
What are my Medicare health plan options?
You can choose different ways to get your Medicare health coverage. Most people get their health care coverage through Original Medicare or a Medicare Advantage Plan (like an HMO or PPO). Your costs vary depending on your coverage and the services you use.
- Original Medicare, which provides Medicare Part A and Part B coverage, is a fee-for-service plan managed by the Federal government.
- This means you are usually charged a fee for each health care service or supply you get. For some services, you will pay an amount called a deductible before Medicare pays its part. Then, when you get a Medicare-covered medical supply or service, Medicare pays its share of the cost of the supply or service, and you pay your share, called the coinsurance or a co-payment.
- You can also join a Medicare Prescription Drug Plan to get Part D coverage.
- Medicare Advantage Plans – health plan options that are approved by Medicare and run by private companies.
- These plans are part of Medicare, and sometimes called “Part C.”
- They provide all your Part A and Part B-covered services.
- Medicare Advantage Plans may offer extra coverage and most include Medicare prescription drug coverage (usually for an extra cost). You may need a referral to see a specialist. In some plans, you can only see doctors who belong to the plan or go to certain hospitals to get covered services.
- In addition to Original Medicare or a Medicare Advantage Plan, you may be able to join other types of Medicare health plans.
When can I make changes to my Medicare coverage?
- You can make changes to your Medicare health or prescription drug coverage between October 15th – December 7th each year.
- If you have a Medicare Advantage Plan, you can dis-enroll from your Medicare Advantage Plan between January 1-March 31 of each year.
- Depending on your situation, there may be other times when you can change your Medicare health or prescription drug coverage.
Can I have other types of health insurance?
- Yes. You may already have health care coverage such as employer or retiree coverage or another type of health insurance. There are times when your other coverage or health insurance must pay before Medicare pays. Talk to your benefits administrator to see how your other coverage or health insurance works with Medicare.
- If you have Original Medicare, you might also want to buy a Medigap policy, sometimes known as a Medicare Supplement Insurance policy. A Medigap policy sold by a private insurance company helps pay some of the health care costs (“gaps”) that Original Medicare doesn’t cover, such as the Part A hospital deductible and the 20% left behind by Medicare.
How can I get help to pay healthcare & prescription costs?
- There are programs that help millions of people with Medicare save money each year.
- If you have limited income and resources, your state may help pay Medicare premiums and in some cases, may also pay Medicare deductibles and coinsurance.
- Help is also available paying prescription drug costs.
- Call 1-800-MEDICARE(1-800-633-4227). TTY users should call 1-877-486-2048.