Medicare Costs and Coverage

Before applying for Medicare, it is a good idea to already know what types of coverage you want to have and how much these coverage options will cost.

It is also important to understand the advantages and disadvantages of each plan and whether you will be required to pay for certain expenses out-of-pocket. There are several different levels of coverage, and four different options available. These options include Part A, Part B, Part C and Part D.

Medicare Part A covers you for hospital and hospice care. Part B is more general, and will cover yearly physical exams, x-rays and more. Part C covers services provided under Parts A and B and acts as a combination plan. Part D is mainly for prescription drug coverage that helps you save money at the pharmacy.

Generally, you must be 65 years of age or older or have a permanent disability in order to enroll in this nationwide health coverage. The cost of Medicare will depend in part on whether you are employed full-time, part-time or retired. You may even have all your healthcare covered if you are eligible for Medicaid as well. This is often called dual eligibility and comes with other benefits, including additional coverage options. Discover more on the cost of Medicare and the different coverage options available with this critical advice.

An Explanation of Medicare Part A

Medicare Part A is often called hospital insurance. Generally, this program does not charge any premiums and all hospital care is covered. Part A also covers hospice care, skilled nursing facility care for a maximum of 100 days and home health services.

Keep in mind that hospital care is only insured when it is inpatient. Though the coverage options in Part A are relatively slim, they are only meant to cover emergencies and other situations that require major care.

You may be eligible for Part A at no additional cost if you meet the age requirement and are eligible for retirement benefits from the Social Security Administration (SSA) or the Railroad Retirement Board (RRB). You may also qualify if a government employer hired you or your spouse for a certain amount of time.

If you do not meet the minimum age requirement, you may be eligible for benefits if you have a disability. Usually, you must have received a minimum of 24 months of SS or RRB disability payments. You may not need to wait 24 months to receive Medicare if you have End-Stage Renal Disease (ESRD).

Some applicants choose to purchase Medicare Part A and pay monthly premiums, even if they do not meet Medicare eligibility requirements. In this case, the amount that a customer must pay each month depends on the number of quarterly taxes he or she has worked as a full-time employee. This is because a certain amount of the applicant’s taxes from each quarter go toward Medicare.

For customers who pay for Part A, the average premium costs between $232 and $422 per month. In addition, they may also have deductibles for inpatient hospital stays and a coinsurance fee. Coinsurance generally begins at $335 for every day of the benefit period, but only starts on the 61st day.

If you become eligible for Medicare Part A and do not sign up for coverage during your initial enrollment period, you may face certain penalties. For instance, you will not be able to apply for coverage until a yearly general enrollment period, and you may have a higher premium to pay each month.

An Explanation of Medicare Part B

Medicare Part B usually provides many more services than Part A. It covers certain types of care that are considered essential coverage, such as preventative services and routine well check-ups with your primary care physician. Other types of care that are covered by Part B include:

  • Medical screenings.
  • X-rays and laboratory work.
  • Ambulatory services.
  • Durable medical equipment (DME).
  • Mental health services, such as inpatient, outpatient, partial hospitalization and counseling.

Unlike Part A, Part B comes with a monthly premium, as well as coinsurance and deductibles. Medicare recipients must pay off their deductibles before their medical expenses are covered. Once the deductible is met, Medicare will pay 80 percent of all approved services.

he average premium for Part B is $134 per month, though this amount may increase or decrease depending on a variety of factors. For instance, a recipient’s premium may decrease if he or she receives SS benefits, but may increase if he or she still earns income and works part-time or full-time.

Premiums may also be higher if an applicant did not apply during his or her initial enrollment period unless he or she applied during a special enrollment period instead.

An Explanation of Medicare Part C

Medicare Part C covers services that are usually covered by either Part A or Part B. Consequently, applicants usually opt for Part A and Part B, or Part C and Part D. The services covered by Part C depend in part on which state an applicant lives in.

Generally, essential healthcare is covered, including regular check-ups, preventative care and hospital care. In some states, dental services, hearing services and vision services are also covered, even though this type of care is sometimes considered supplemental. Some Medicare Part C plans even include prescription drug coverage, which means that customers would not need to purchase Part D.

Part C is similar to Part B because it comes with monthly premiums, deductibles and coinsurance. The cost of these expenses will vary depending on the types of coverage you choose and other factors. It will also vary depending on your location within the U.S.

An Explanation of Medicare Part D

Applicants who enroll in traditional Medicare, meaning Parts A and B, also have the option to purchase Part D. Part D covers prescription drugs and is sometimes added to Part C as well, if recipients want to avoid a gap in their coverage.

There are a variety of Part D plans available which vary in price and drugs that are insured. Generally, the price of this plan will depend on the drugs prescribed by your doctor. Part D may only reduce the price of prescription drugs and may not cover the entire expense.