A Beginner’s Guide to Medicare Pt 1

As a freshman in Medicare, you may be confused about your Medicare insurance options. You can have many options, often with different rules, limits, doctors and costs. They worked hard to get Medicare. Now is the time to make sure that Medicare works hard for you and that you get the insurance you are satisfied with. Learn more about Medicare Part A and Part B (collectively called “Original Medicare”), Part C (usually called “Medicare Advantage”), and Part D (the part of Medicare that insures your drug). You will also learn about the cost of Medicare.

What is Original Medicare?

Original Medicare is Part A and B. Most people think that Medicare Part A is “hospital insurance.” It helps to insure services such as (but not limited to):

  • Hospitalization
  • Hospice care
  • Care from skilled nursing facility.
  • Home health services

Most people do not pay any monthly cost for Medicare Part A plan. Generally, you do not have to pay a Part A cost so long as you or your husband/wife has paid for Medicare tax in the last 10 years (i.e. 40 quarters) when you were working (or when your spouse worked). However, your insurance for Part A may include other costs, such as deductibles, co payments and/or co insurance when you claim insurance.  Many people believe that Medicare Part B is “medical insurance.” It helps insure the services and consumables needed to diagnose or treat your health, including:

  • doctor visits
  • Durable medical equipment
  • ambulance service
  • Laboratory tests and x-rays.
  • Various checks

Generally, you pay a monthly premium for Medicare Part B. The amount you pay depends on your specific situation.  In addition to your monthly premium, people with Part B have an annual deductible and coinsurance. Before the deductible is collected, you will pay for all Medicare-approved medical expenses you receive during the year (the deductible does not apply to all services and some services may be available for free, such as the annual flu shot). When it has been fully met, you will usually only pay 20% of the Medicare approved amount for most of the insured services in Part B for the rest of the year.

What is an alternative way to get my original Medicare benefits?

Some people opt for Medicare benefits through Medicare Part C, also known as Medicare Advantage. These are private health policies approved by Medicare for people enrolled in Medicare Part A and B.  Medicare Advantage policies will provide you with all the health and medical insurance you would receive under Medicare Part A and Part B (apart for hospice care, which is still in Part A). In addition, they often offer additional benefits, such as:

  • Routine dental services.
  • routine vision services
  • Prescription drug insurance
  • hearing coverage

Maximum amounts out-of-pocket (to limit your out-of-pocket Medicare spending to a certain amount each year)  Many 2019 Medicare Advantage policies have networks of specific providers. This means that you may need to visit certain doctors or visit certain hospitals to benefit from your policy.