Understanding the Basics: Medicare Parts A, B, C, and D
Many people look forward to receiving Medicare benefits as they get older. However, understanding how Medicare works and navigating the system is often overwhelming, particularly if you’re enrolling for the first time.
Medicare coverage can be broken down into four parts: A, B, C, and D. Each covers different aspects of your medical care, meaning each has different qualifications, benefits, and coverage elements.
At Senior Insurance Agency, we want to ensure you’re aware of all your Medicare options. Understanding how the 4 parts of Medicare work can help you get the coverage you need — so let’s break it down.
What is Medicare?
Medicare is a federal health insurance program available to those over the age of 65. Medicare is also available to patients under the age of 65 with certain disabilities or who have end-stage renal disease. The program is run through the Social Security Administration and the Centers for Medicare & Medicaid Services (CMS).
Medicare Parts A and B combine to form Original Medicare. With Original Medicare, the federal government pays directly for your healthcare, and you can go to any doctor who accepts Medicare coverage. There are also limits on the amount that doctors can charge Medicare patients.
Part A: Hospital Insurance
What does Medicare Part A cover? Medicare Part A covers hospital stays and inpatient care. Part A also covers hospice care, skilled nursing facility care, and home health care in some instances.
Most people don’t pay a monthly premium for Part A coverage if they worked and contributed to FICA taxes for 40 quarters throughout their life. They will have a deductible, which is the amount they’ll pay out-of-pocket for hospitalization before Medicare kicks in. The Part A deductible for inpatient hospital stays is $1,632 in 2024.
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Part B: Outpatient Medical Coverage
Medicare Part B covers a variety of outpatient services and preventive services. This includes visits to both your primary care doctor and specialists, as well as screenings, lab tests, certain vaccines, X-rays, and medical equipment.
Most people will need to pay a premium for Part B medical insurance. The standard monthly premium for Medicare Part B in 2024 is $174.70 per month. However, some people may pay more based on their yearly income.
There is also an annual deductible for Medicare Part B, but it is much lower than the Part A deductible. For 2024, the Part B deductible is $240. Beneficiaries may have to pay coinsurance for some covered services after the deductible is met.
Part C: Medicare Advantage Plans
Medicare Part C, also known as Medicare Advantage, functions as a private alternative to Original Medicare. Medicare Advantage plans are provided by private health insurance companies and regulated by CMS.
Medicare Advantage plans cover the same services as parts A and B, as well as a range of additional coverage options. Exact Medicare Part C coverage will vary depending on the individual plan and company you choose.
Many Medicare Advantage plans offer prescription drug coverage as an alternative to Part D coverage. Some plans also offer other add-ons like dental and vision benefits. With most plans, you will be limited to doctors that work with your insurance company, rather than having the option to see any doctor that accepts Medicare.
Monthly premiums, deductibles, and other out-of-pocket costs will vary depending on the specific Medicare Advantage plan you have. In some cases, Medicare Advantage plans are more expensive than Original Medicare, but they can also come with more extensive coverage.
Medigap Plans
Medicare Parts A, B, C, and D offer coverage for a wide range of medical expenses. However, beneficiaries with Original Medicare will still have many out-of-pocket costs to worry about, including monthly premiums, deductibles, and coinsurance.
Medigap plans are optional plans offered by private insurance companies that can help address out-of-pocket costs after your Medicare coverage. These insurance plans are designed to complement Original Medicare and make medical costs more manageable. Many beneficiaries opt to pair Original Medicare with Medigap coverage and a Part D prescription drug plan, rather than choosing a Medicare Advantage plan. A good fit for you will depend on your individual medical needs and financial goals.
Part D: Prescription Drug Coverage
Medicare Part D plans cover prescription drugs and are run by private insurance companies. If you have Original Medicare, you can purchase a standalone Part D plan. Many Medicare Advantage plans also include prescription drug coverage.
Medicare Part D plans come with monthly premium costs, which will vary depending on your insurer and the exact plan you choose. In the state of Nevada, 2024 premiums range from $0 per month to $120 per month.
Most Medicare Part D plans break their coverage into tiers, which determine the copayment for each covered drug. Drugs on the lowest tiers have the lowest copayments, with copayments increasing as they move up the tiers.
Get Medicare Coverage With Senior Insurance Agency
Medicare makes healthcare more affordable and accessible for many older adults and people with disabilities. As you become Medicare-eligible, understanding how each part works can help you find coverage that works for you.
At Senior Insurance Agency, we help Medicare beneficiaries in Nevada navigate the complex Medicare system. Our knowledgeable agents will walk you through the system and help you understand all your coverage options before deciding.
Everyone has different financial and healthcare needs. We’ll get to know you and make personalized recommendations for your situation.
If you’re ready to learn more about your Medicare options, contact Senior Insurance Agency today to get started.