Medicare Part A Covers
Medicare Part A is hospital coverage. It covers care you receive while an inpatient in a hospital or skilled nursing facility. Medicare manages Part A coverage and costs based on a benefit period. The Part A deductible, for example, is charged for each benefit period.
Medicare Part B Covers
Medicare Part B is medical coverage. It covers doctor visits, clinic services and care you receive as an outpatient.
What Part A & Part B (Original Medicare) Doesn’t Cover
Original Medicare (Parts A and B) covers many medical and hospital services, but it doesn’t cover everything. Many people are surprised to learn that prescription drugs aren’t covered. Prescription drug coverage can be purchased through Medicare Part D, but it’s not provided by Part A or Part B. You may have to pay for these services yourself unless you have other insurance that covers them. Some Medicare Advantage (Part C) plans may help with certain services not covered by Original Medicare.
Here are some other services that are not covered by Original Medicare:
- Dental exams, most dental care or dentures
- Routine eye exams, eyeglasses or contacts
- Hearing aids or related exams or services
- Most care while traveling outside the United States
- Help with bathing, dressing, eating, etc. (custodial care)
- Comfort items such as a hospital phone, TV or private room
- Long-term care
- Cosmetic surgery
- Most chiropractic services
- Acupuncture or other alternative treatments
- Routine foot care
Medicare Advantage (Part C) Covers
Medicare Part C is also called Medicare Advantage. These plans combine the coverage of Parts A and B into one plan. They often include prescription drug coverage and other services such as dental, vision and hearing care, as well.
Medicare Part D Covers
Medicare Part D is prescription drug coverage. It helps pay for medications your doctor prescribes. You can get a standalone Part D plan or get a Medicare Advantage plan that includes drug coverage.
Medicare Supplement Insurance: Medigap
Medicare Supplement Insurance, also known as Medigap, helps pay some out-of-pocket costs that come with Original Medicare. There are 10 Medicare supplement insurance plans standardized by the federal government. Each is labeled with a letter. Every plan with the same letter offers the same benefits, no matter what state it’s offered in or by which insurance company. Massachusetts, Minnesota and Wisconsin have different plans. The level of coverage varies. There are standardized plans that cover all Medicare deductibles, copayments and coinsurance, while others leave some costs for you to pay on your own. Medicare supplement plans provide nationwide coverage.
You may enroll in a Medicare supplement plan at any time, but you may be denied coverage or charged more based on your health history if you enroll after your Medicare Supplement Open Enrollment Period.
Medicare Coverage Combinations:
Additional coverage can be added to Original Medicare or you can choose a Medicare Advantage plan that has all the coverage you need. You may add a standalone Part D plan, a Medicare supplement plan or both to Original Medicare (Parts A & B).
Original Medicare (Parts A & B) or just Part A or just Part B
Original Medicare (Parts A & B) plus a standalone Part D plan
Original Medicare (Parts A & B) plus a standalone Part D plan plus a Medicare Supplement plan
Original Medicare (Parts A & B) plus a Medicare Supplement plan
A Medicare Advantage (Part C) plan with built-in drug coverage
A Medicare Advantage (Part C) plan without drug coverage
A Medicare Advantage (Part C) plan without drug coverage plus a standalone Part D plan, only works with certain Medicare Advantage plan types
Note: Combination 7 is only available if you choose a Private Fee-For-Service (PFFS) Medicare Advantage plan without drug coverage or a Medicare Savings Account (MSA) plan. These are the only types of Medicare Advantage plans that can be combined with a standalone Medicare Prescription Drug plan.
Medicare CostsMedicare helps pay for many health care items and services, but you will pay a share of the cost, as well. Your Medicare costs include:
A premium is a fixed amount that you pay. Depending on your coverage, you may pay a premium to Medicare, to a private insurance company or to both. Most premiums are charged monthly and can change from year to year.
A deductible is a set amount that you pay out of pocket for covered services before your plan begins to pay.
A co-payment, or co-pay, is a fixed amount you pay at the time you receive a covered service. For example, you might pay $12 when you fill a prescription or $20 each time you go to the doctor.
Co-insurance is when you and your plan split the cost of a covered service. For example, your plan might pay 80% and you would pay 20% of the allowed amount.
How do I choose a Medicare plan?Think about your needs so you can see how different coverage options might work for you. Answering the following questions can help you get started.
How is your health?
- How often do you go to the doctor?
- What health problems do you have?
- What medications do you take regularly?
What are your preferences?
- Which doctors, hospitals and pharmacies do you like to go to?
- How important is it for you to have access to health care while traveling?
- What other coverage do you have, such as an employer or retiree plan?
What is your budget?
- What are you able to pay each month in premiums?
- How comfortable are you covering co-pays or co-insurance for health services?
- What is your risk tolerance of high out-of-pocket costs?
Enrolling in a Medicare Plan
Initial Enrollment Period
The Initial Enrollment Period (IEP) is 7 months long. It includes your 65th birthday month plus the 3 months before and the 3 months after. It begins and ends 1 month earlier if your birthday is on the first. You may enroll in Original Medicare – Part A, Part B or both. You can also choose to join a Medicare Advantage plan (Part C) or a prescription drug plan (Part D).
General Enrollment Period
The GEP happens every year from January 1 to March 31. You may use the General Enrollment Period (GEP) to enroll in Original Medicare – Part A, Part B or both if you miss your IEP. You can also choose to join a Medicare Advantage plan (Part C) or a prescription drug plan (Part D) from April 1 to June 30 the same year.
Medicare Supplement Open Enrollment Period
The Medicare supplement open enrollment is 6 months long. It begins the month you are 65 or older and are enrolled in Medicare Part B. You cannot be denied coverage or charged more based on your health history if you enroll during your open enrollment. Some states may allow for additional Open Enrollment Periods.
Special Enrollment Period: Working past 65
You may qualify for a Special Enrollment Period (SEP) to enroll in Original Medicare – Part A, Part B or both without penalty for up to 8 months after the month your (or your spouse’s) employment or employer coverage ends, whichever comes first. You can also join a Medicare Advantage plan (Part C) or prescription drug plan (Part D) up to 2 full months after the same event, if you are eligible.