Basics of Medicare – Parts A, B, C, & D

Medicare can be confusing. Let’s cover some of the basics.

What is Medicare Part A?  Hospital Insurance.

Medicare Part A covers the following services:

After being formally admitted to a hospital by a doctor, you get inpatient hospital treatment. In addition to 60 lifetime reserve days, you are protected for up to 90 days throughout each benefit term in a general hospital. Additionally, 190 lifetime days in a psychiatric hospital are covered by Medicare up to a total of 190 days.

Care provided in a skilled nursing facility (SNF): Medicare pays lodging, meals, and a variety of services offered there, such as medication administration, tube feedings, and wound care. If you are eligible for coverage, you are protected for up to 100 days throughout each benefit period. You must require skilled nursing or therapy services and have required at least three consecutive days as a hospital inpatient within 30 days of admission to the SNF to be eligible.

Medicare will pay for services provided to you at home if you require skilled care and are confined to your home. You are covered for unlimited intermittent care visits or up to 100 days of daily care. You must have spent at least three continuous days as a hospital inpatient within 14 days of obtaining home health care to be eligible for Part A coverage.

You may choose to get hospice care if a doctor thinks you have a terminal illness. As long as your provider verifies that you require care, you are covered.

Remember that Medicare typically only covers a fraction of the cost of your care; you will likely be liable for some cost-sharing (deductibles, coinsurance, and copayments) for services covered by Medicare.

Because they or their spouses have 40 or more quarters of Medicare-covered employment, the majority of people do not pay a monthly Part A premium. The Part A cost in 2022 is $499 per month for those with fewer than 30 quarters of Medicare-covered employment. The Part A premium for someone with 30 to 39 quarters of Medicare-covered employment is $274 per month.

What is Medicare Part B?  Medical Insurance.

Outpatient/medical coverage is provided under Medicare Part B. A summary of Part B-covered services and coverage guidelines can be found in the list below:

Services provided by a licensed health practitioner that you need for a medical condition.

Equipment that has a medical function is strong enough to sustain repeated usage, and is suitable for use in the home is known as durable medical equipment (DME). Examples include wheelchairs, oxygen tanks, and walkers. When your provider certifies that you require DME and you can afford it, you can buy or rent it from a Medicare-approved supplier. Long-Lasting Medical Equipment

Services are provided if you are confined to your home and require specialized nursing or therapy.

Emergency transportation is provided by ambulance services, usually to and from hospitals. Only circumstances in which there is no safe alternative form of transportation and when the transportation is medically necessary are covered for non-emergency ambulance/ambulance transportation.

Preventive services: These are examinations and counseling meant to keep you healthy and free from disease. Preventive care is typically coinsurance-free under Medicare.

Services gave by a therapist for who Medicare qualifies to include outpatient physical, speech, and occupational therapy.

psychiatric services

lab tests and X-rays.

chiropractic treatment when spinal manipulation is required by medicine to correct a subluxation (when one or more of the bones of the spine move out of position).

a few prescription medications, such as immunosuppressants, some anti-cancer medications, some anti-emetic medications, some dialysis medications, and medications that are usually delivered by a doctor.

This list includes products and services that are frequently covered, but it is not all-inclusive. Remember that Medicare typically only covers a fraction of the cost of your care; you will likely be liable for some cost-sharing (deductibles, coinsurance, and copayments) for services covered by Medicare.

The Part-B premium for 2022 is $170.10 per month; rates for those with yearly incomes of at least $91,000 and married couples earning at least $182,000 will be higher.

For information on the Medicare Part A and Part B deductibles and co-insurances, please see the page Medicare Part A and B Premiums, Deductibles, and Co-Insurances. 

What is Medicare Part C?  Medicare Advantage Plans.

Instead of using Original Medicare Parts A and B, you can choose to receive your Medicare coverage through a Medicare Advantage Plan (Part C).

Medicare Advantage Plans may do so with different guidelines, fees, and coverage limitations, but they must offer at least the same benefits as Original Medicare (those covered under Parts A and B). Additionally, Part D is typically included in your Medicare Advantage benefits package. There are numerous varieties of Medicare Advantage Plans. In addition to your Part B premium, you might have to pay a monthly premium for this insurance.

When you visit a doctor or hospital, you won’t need to use your red, white, and blue Medicare card if you enroll in a Medicare Advantage Plan. You will instead use the membership card your private plan sends you to access covered medical services. If your health plan covers Medicare prescription drugs, you will also use this card at the pharmacy.

What is Medicare Part D? Prescription Drug Coverage.

The portion of Medicare that covers outpatient medications is known as Part D or the Prescription Drug Benefit. Part D is never provided directly by the government, unlike Original Medicare, but only through private insurance companies that have agreements with the federal government.

You must select and enroll in a private Medicare prescription drug plan (PDP) or a Medicare Advantage Plan with drug coverage if you want Part D coverage.

Enrollment is only permitted during designated enrollment periods and is optional, though it is strongly advised to avoid future penalties. Normally, you should enroll in Part D as soon as you are first eligible to join Medicare.

Depending on your situation, you should decide if you want to enroll in a Medicare Part D plan. Your employer’s or retiree’s insurance may provide creditable drug coverage. If so, you can wait to sign up for a PDP until your current coverage expires. Additionally, some individuals who are already enrolled in specific low-income assistance programs might be automatically enrolled in a Medicare drug plan and receive additional financial support for the cost of their medications.

What is a Medicare Supplement Plan? 

Health insurance plans called Medicare Supplement Plans (not Medicare Advantage) provide standardized benefits to work with Original Medicare. Private insurance companies sell them. If you have a supplement plan, it covers some or all of the costs that Original Medicare does not cover. These plans might pay for unpaid deductibles, copayments, and coinsurance. They might also pay for medical expenses that Medicare doesn’t cover at all, like treatment received while traveling abroad. Keep in mind that Medicare Supplement Plans only function with Original Medicare. You cannot purchase a Medicare Supplement Plan if you have a Medicare Advantage Plan.

There are up to ten different Medicare Supplement insurance available depending on where you live: A, B, C, D, F, G, K, L, M, and N. (policies in Wisconsin, Massachusetts, and Minnesota have different names). Every insurance delivers a unique set of standardized benefits, therefore benefits offered by policies with the same letter name are identical. Premiums, however, can differ from one company to another. Note: Only applicants who become Medicare-eligible for the first time before 2020 are permitted to purchase Plans C, F, and high deductible F.