Medicare is the health insurance program for people 65 or older, younger people with disabilities, and people with End-Stage Renal Disease (ESRD) or ALS.
See Where You StandMedicare consists of four different parts:
- Medicare Part A, hospital insurance
- Medicare Part B, medical insurance
- Medicare Part C, Medicare Advantage
- Medicare Part D, prescription drug coverage
Together, Parts A and B make up what's known as Original Medicare.
Medicare Part A
Medicare Part A, hospital insurance, covers:
- Inpatient hospital care when you're admitted to the hospital as an inpatient after a doctor's order says it's necessary and the hospital accepts Medicare (in some cases, the hospital's Utilization Review Committee of the hospital will need to approve your stay)
- Skilled nursing facility care when you have a qualifying hospital stay and your doctor has decided you need daily skilled care related to your qualifying hospital stay
- Nursing home care when custodial care isn't the only kind of care you need and it's been deemed medically necessary for you to have skilled nursing care
- Hospice care including all items and services needed for pain relief and symptom management, pain management drugs, durable medical equipment for pain relief and managing symptoms, aide and homemaker services, spiritual and grief counseling for you and your family, and medical, nursing, and social services
- Some home health care, usually including part-time skilled nursing care, occupational therapy, physical therapy, medical social services, speech-language pathology services, part-time home health aide services, and injectable osteoporosis drugs for women
Medicare Part B
Medicare Part B provides coverage for medically necessary services and preventive and screening services.
Medically necessary services include services or supplies that are needed to diagnose or treat your medical condition. Preventive services include medical care to prevent illness or detect it early when treatment is likely to be most effective.
Part B covers things like:
- Durable medical equipment
- Clinical research
- Mental health - inpatient, outpatient, and partial hospitalization
- Ambulance services
- Limited outpatient prescription drugs
- Screenings
- Shots
- A yearly wellness visit, and more
Medicare Part C
Medicare Part C, also known as Medicare Advantage, is a bundled alternative to Original Medicare. Part C is offered by Medicare-approved private companies that are required to follow Medicare's rules. Most Medicare Advantage plans include prescription drug coverage, but you will need to check with the plan beforehand to determine if this coverage is included, and which prescriptions are included. These plans may also include vision, hearing, dental, and/or coverage for fitness programs, but again, this coverage depends on the plan.
These plans set a limit on your out-of-pocket costs each year for covered services to protect you financially. Most plans require you to use medical providers who are in-network for the plan, although some plans offer out-of-network coverage at a higher cost.
There are five different types of Medicare Advantage plans:
- Health Maintenance Organization (HMO) Plans
- Preferred Provider Organization (PPO) Plans
- Private Fee-for-Service (PFFS) Plans
- Special Needs Plans (SNPs)
- Medicare Medical Savings Account (MSA) Plans
HMO plans and PPO plans are the two most popular Medicare Advantage options.
Medicare Part D
Medicare Part D provides coverage for the cost of prescription drugs. Each Part D plan must cover at least two drugs from each category, as well as any drug that falls under one of these specific categories:
- Anticancer
- Antipsychotics
- Anticonvulsants
- Antidepressants
- Immunosuppressants
- Antiretrovirals (HIV/AIDS treatment)
Need Help Deciding On Your Medicare Coverage?
Medicare decisions do not have to be confusing or stressful. We work hard every day to analyze plan options and help you find a setup that fits your doctors, prescriptions, and budget.
Reach out to Simple Retirement Benefits
Still weighing your Medicare options? We'll walk through them with you and narrow the list to the plans that fit your doctors, prescriptions, and budget.