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What is Medicare and What Does It Cover?

You’ve come to the right place for your Medicare information. We hope you will learn as much as your heart desires and we definitely want to hear from you and want to help you every step of the way. 

Medicare is a health insurance program that provides coverage to millions of Americans. It is administered by the Centers for Medicare and Medicaid Services (CMS) and covers a variety of medical services, including hospital care, doctor visits, prescription drugs, and more.

Most of us know about Medicare as our parents were and/or are still on it.  That being said we will answer this question of What is Medicare, and several other questions like; how does it work? What Does Medicare Cover? What are all of the different parts of Medicare? 

We will also discuss how to enroll in Medicare and tips for using its benefits.

So, if you are wondering what Medicare is all about or are thinking about enrolling in the program, keep reading!

Let’s define Medicare coverage!

Original Medicare is a federal health insurance program that was designed for people 65 and older. Most people think this program is 100% free however, as you will learn this is not the case.   There are many different costs associated with this program depending on which product you obtain.

Medicare also helps those individuals that meet specific disabilities guidelines or have been diagnosed with end-stage kidney failure. Medicare is broken down into specific “Parts” and each Part provides different layers of coverage.  When you obtain all of the Parts of Medicare together it creates a pretty comprehensive program.

While Original Medicare is comprehensive coverage it does leave behind some gaps in coverage.  The great news is there are additional programs that help fill in those gaps.  Depending on which direction you go these programs can fill in nearly 100% of the gaps.

What are all of the Medicare Part's

What are the Different Parts of Medicare?

Medicare is a federal health insurance program for people who are 65 or older, people under 65 with certain disabilities, and people of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a transplant).

There are four parts to Medicare: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage Plans), and Part D (Prescription Drug Coverage). 

We will continue to explore all of these parts of Medicare below.

What is Part A and what does it cover?

Medicare Part A under Original Medicare is your hospital insurance coverage that assists you with the cost of inpatient care.  You also have additional coverages that go beyond hospital care such as Hospice, skilled nursing facility, and home health care. 

As you can see this is much more than just Hospital coverage.  

For most Americans, this coverage Part will come to you at no additional cost as you have already paid for this coverage through your payroll taxes.  If you did not work a total of 40 quarters or 10 years you can incur a separate monthly cost. 

You can log into your Social Security portal to confirm you have all 40 quarters.

Original Medicare covers most of the cost associated with your Part A coverage.  There are deductibles and copays that you may have as part of your stay at each of these facilities. 

If you obtain a Medigap policy or Medicare Advantage plan some if not all of these costs can be paid for up to 100% of the cost.

Original Medicare Part B

What is Part B and what does it cover?

Medicare Part B covers you for most medical needs that fall outside of Part A coverage  Most of us see Part B as your coverage for your primary care Doctor or Specialist, however, it provides many other coverages that fall outside of seeing your health care providers.  

Some of these services include Outpatient surgeries, Lab work, durable medical equipment, preventive services, radiology, CT Scans, MRI, kidney dialysis, cancer therapy, and Ambulance services. There are many other services that your Part B coverage will provide medical coverage for.

With the ever-changing world of how medical procedures are now done as compared to 20-plus years ago, most people will use their Part B coverage far more than they will use their Part A coverage. 

Similar to your Part A coverage your Part B coverage also has coverage gaps that can end up costing you thousands of dollars.  This is why it is important to have a Medigap plan or Medicare Advantage plan in place to help fill in the gaps left behind by Original Medicare.  

If you would like to learn more about Medicare Part B we recommend that you visit this page.  We will take a much more in-depth look at Medicare Part B.

Medicare Advantage Plans

What is Medicare Part C?

Medicare Part C is more commonly known as a Medicare Advantage plan.  Your local Medicare Insurance Agent is your main point of contact for signing up for one of these plans. 

This is not a coverage that you sign up for your Social Security office but rather is a secondary option that is available to you if you so chose. 

Most insurance Agents and people, in general, define Part C  as the Medicare Advantage program. The cost and coverage of a Medicare Advantage plan vary by carrier, State, county of residence, zip code, and plan selected. 

Medicare Advantage plans are provided by private insurers, and depending on where you live may charge monthly premiums for their Medicare benefits.

Some Medicare beneficiaries will pay as little as $0.00 per month while others could pay as much as $300 or more per month.  This is in addition to the premium you will need to pay towards your Part B monthly premium. 

It is important to use a Medicare insurance broker to review your health insurance coverage needs and find a health insurance company that is best for your medical needs.

For the 2022 plan year, your Part B monthly premium is $170.10.

Signing up for both Medicare Parts A and B is a requirement before you are able to enroll in a Part C plan.  It is very important that you continue to pay your Part B premium each month or you will be disenrolled from your Medicare Advantage plan. 

Unlike Original Medicare with a Medigap plan, Medicare Advantage plans require you to live in the plan service area as most of these plans are considered HMO. Once you enroll in a Medicare Advantage plan, your Medicare coverage will come from the Advantage plan itself, and not from the federal government or Original Medicare which is a PPO-style plan.

You are not required to enroll in Part C – Medicare Advantage Plans and by doing so you give up your rights given to you by Original Medicare.  By signing up for a Medicare Advantage plan you agree to allow the Insurance Carrier to decide what is covered and what is not covered. 

Many people prefer to get their Medicare coverage from Original Medicare and purchase a separate Medicare Supplement plan aka a Medigap plan.

These people do not want a Part C Advantage plan as they don’t want to give up their rights that are proved under Original Medicare, so they will simply not enroll in one.  In addition, they prefer to have their Doctor decide what is medically necessary and not the plan’s network.

It is your choice whether you wish to opt into an Advantage plan as opposed to just staying with your original Medicare Parts A and B and signing up for a Medigap plan.

Part D Prescription Drugs Plan

What is Medicare Part D?

Medicare Part D provides you with Medicare prescription drug coverage.  For many years people, 65 and older had to take on 100% of the health care costs associated with their prescription drugs.  This all changed with the rollout of Part D coverage.  

While this coverage is not perfect and if you are a heavy user you could incur some pretty expensive bills even with this coverage in place.  Congress has made some efforts in reducing what is known as the donut hole.  In our opinion, there is still a lot of work that needs to be done.

With this coverage, you have several options when it comes to getting your Medicare prescription drug coverage.  You can either pick up a 30, 60, or 90-day supply at your local pharmacy or you could request mail orders. 

We recommend evaluating the cost of these two options.   Many times you can reduce your cost by ordering through mail orders while other times it will cost you less to pick up your drugs at a local pharmacy. 

Medicare Part D can be purchased either on a standalone basis or through a Medicare Advantage plan.  If you purchase it through a Medicare Advantage plan you are not allowed to obtain a separate standalone Part D plan. 

What is not covered by Medicare

What does Medicare cover and what doesn't it cover?

Medicare does not cover all medical expenses, however. There are four parts to Medicare: Part A covers hospital insurance, Part B covers medical insurance, Part C is Medicare Advantage, and Part D covers prescription drugs.

Each part has different coverage and costs.

  1. Part A has no monthly premium, but it does have a deductible.

  2. Part B has a monthly premium, as well as a deductible and coinsurance.

  3. Part C plans have a monthly premium, and some also have a deductible and coinsurance.

  4. Part D plans have a monthly premium, and some also have a deductible, coinsurance, and copayments.

There are also many services that Medicare does not cover, such as long-term care, dental care, eyeglasses, and Hearing aids.

To learn more about what Medicare covers and doesn’t cover, visit the Centers for Medicare and Medicaid Services website.

How do I sign up for Original Medicare and When should I sign up?

If you are already receiving Social Security benefits, you will automatically be enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance).

If you are not receiving Social Security benefits, you can sign up for Medicare by visiting the Social Security Administration website or by calling their toll-free number at 1-800-772-1213.

You should sign up for Medicare three months before your 65th birthday, even if you are not receiving Social Security benefits.

If you do not enroll during the initial Medicare enrollment periods, you may have to pay a late enrollment penalty.

You can also sign up for Medicare during the seven-month period that begins the month after you stop working or your group health coverage ends, whichever comes first.

For more information about signing up for Medicare, visit the Centers for Medicare & Medicaid Services website or call their toll-free number at 1-800-MEDICARE (1-800-633-4227).

Medicare Card

Once I receive my Medicare Card What Do I do Next?

If you’re new to Medicare, you may be wondering what to do next after you receive your Medicare card.

The first thing you should do is familiarize yourself with the different parts of Medicare.

Medicare Part A covers hospital insurance, while Medicare Part B covers medical insurance. You can also choose to enroll in Medicare Part D, which covers prescription drugs.

Once you know what each part of Medicare covers, you can start looking into which plan options are best for you.

There are two Different Types of Plan Options to Consider: a Medicare Supplement Plan and A Medicare Advantage Plan

A Medicare Supplement plan which is also referred to as a Medigap Plan is a health insurance policy that helps pay for some of the costs that Original Medicare doesn’t cover, such as copayments, coinsurance, and deductibles.

A Medicare Advantage Plan is a health insurance policy that provides all of your Part A and Part B coverage, and usually Part D as well, in one plan.

There are many different Medicare Advantage Plans to choose from, so it’s important to compare plans before enrolling in one.

You can also switch plans at any time during the year if you decide that a different plan would be better for you.

With a little research and planning, you can ensure that you have the coverage you need to stay healthy and protect your finances.

Parts of Medicare

How much will my monthly premium be for Medicare Part A, B, C, or D in 2022?

The amount you pay for your Medicare Part A, B, C, or D monthly premium in 2022 will depend on a number of factors, including your income and the coverage you choose.

The Part A premium for 2022 is zero unless you did not work enough time to pay into Medicare, and the standard Part B premium is $170.10.

However, if your income is high, you may have to pay an additional surcharge.

For Part C (Medicare Advantage), premiums will vary depending on the plan you choose.

And for Part D (prescription drug coverage), premiums will range from $10 to $150 per month.

You can get more details about Medicare Part A, B, C, and D premiums for 2022 from the Centers for Medicare & Medicaid Services website.

What if I'm already receiving Social Security benefits - do I need to sign up for Medicare too?

If you’re already receiving Social Security benefits, you’re automatically enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance).

You’ll get your Medicare red, white, and blue card in the mail 3 months before your 65th birthday.

If you’re not receiving Social Security benefits, you can sign up for Medicare online, in person, or by calling 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

You can sign up for Part A and/or Part B during: 

  • Your Initial Enrollment Period – begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65 
  • A Special Enrollment Period – if you have coverage through a group health plan based on having a job or on your spouse’s job. If your employer has 20 or more employees, you don’t need to sign up for Part B. 
  • A General Enrollment Period – from January 1 to March 31 each year if you didn’t sign up when you were first eligible. Your coverage will begin on July 1 of that year. 

Are there any other options available if I don't want to enroll in traditional Medicare?

When it comes to health care coverage, there are many options available to seniors. Traditional Medicare is one option, but it is not the only option.

If you are not interested in enrolling in traditional Medicare, you may want to consider Medicare Advantage plans.

These plans offer the same benefits as traditional Medicare, but they are usually offered through private insurance companies.

Another option is Medicare Supplement insurance. These plans can help to cover some of the costs that Original Medicare does not cover, such as deductibles and copayments.

There are also many prescription drug plans available that can help to lower the cost of your medications.

Ultimately, there are many different health care options available to seniors, so it is important to do your research to find the best option for your needs.

Medicare Agent

We are here to Help you

We love our job and that is because we love our clients.  We are here to help you find the right plan option that works best for you.  No two people have the same needs when it comes to Medicare needs.  Everyone’s health-related needs are all different.  

We created this site because if you are like me you want to be prepared. Research is what we love to do for our clients.  We spent years working to perfect this website so it can answer most if not all of your questions.  We want you to feel confident in our abilities to help you find the best coverage options.

We look forward to hearing from you and/or your family member.

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