Medicare 101 – Your guide for 2019
What you need to know.
Your Medicare Guide
The following Medicare guide will help you get a clearer picture. Medicare is the United States’ health insurance program for seniors 65 and older, and people who are legally disabled. It is unlike any other health insurance and can be difficult to learn. Many people don’t expect Medicare to be as confusing as it is and therefore, put off learning about it until last minute.
If you fail to learn at least the basics of Medicare, you could find yourself owing penalties or even without coverage. The easiest way to learn Medicare is to break it up into easy-to-swallow, bite-size pieces.
Medicare Part A
Medicare Part A is your designated inpatient hospital coverage. It covers a semi-private hospital room as well as your meals while you’re an inpatient. Part A also covers your recovery stay in skilled nursing facilities.
Part A is the only part of Medicare you pay into while working and paying taxes. That’s why it is generally the only part of Medicare you get premium-free. However, Part A has other charges you’ll be responsible for. Part A has a deductible and copayments.
The Part A deductible in 2019 is $1,364, and it’s per benefit period. A benefit period by definition is “a length of time during which a benefit is paid.” You can have multiple Part A benefits per year if you have a chronic or serious illness.
This deductible also covers your first 20 days spent in a skilled nursing facility after you’ve been in the hospital for at least three days. If you stay in the hospital or skilled nursing facility longer than 60 days or 20 days, respectively, then you will start paying a daily copay for every day after.
Medicare Part B
Medicare Part B is designed to cover your outpatient medical services and items. It covers things such as doctor visits, durable medical equipment, lab work, and much more. Because you don’t pay into Part B, you will have a monthly premium once you’re enrolled.
Most Medicare beneficiaries pay the base premium for Part B each year. As of 2019, the base premium is $135.50. The Part B premium is based on income. If you’re in a higher income bracket, you could pay more than the base premium.
Part B also has other costs such as copayments, coinsurance, and a deductible. The Part B deductible is unlike Part A’s because it is an annual deductible. The 2019 deductible for Part B is $185. Once you have met your deductible, Part B will cover 80 percent of your Medicare-approved outpatient services. You will be responsible for the 20 percent coinsurance.
Medicare Part C – Medicare Advantage
Medicare Part C is where most people start to get confused. That is because Part C, also called Medicare Advantage (MA), is an optional part and is not sold to you by Medicare. MA plans are sold by private insurance carriers. This type of plan takes over your care and pays instead of Original Medicare (Part A and Part B).
Although MA plans take over your health insurance, you still have to have to be enrolled in Part A and Part B to have an MA plan. These plans are similar to the type of insurance you likely had through your employer, pre-retirement. They have deductibles, copays, coinsurance, and out-of-pocket (OOP) maximums.
Some people choose an MA plan over Original Medicare because of the extra benefits they usually offer. Medicare doesn’t cover things such as dental, vision, and hearing. These are benefits many MA plans cover.
The premiums, copays, deductibles, etc. all differ from plan to plan. The carrier themselves set these costs. The carriers also set the provider networks per plan. This means your plan will determine which doctors you can get full coverage for.
If you’re looking to buy one, do check out Health.com’s comprehensive study on the best Medicare Advantage plans.
Medicare Part D
Medicare Part D is dedicated to covering your retail prescription drugs. These are similar to Part C plans since they are sold by private insurance carriers rather than Medicare. Again, the carriers set the premiums, deductibles, and coinsurance.
Each Part D plan has four payment stages that you move through throughout the year. The stage you’re in will determine how much you pay for your prescription. Part D plans also have formularies that list the drugs they cover.
Medicare Supplement – Medigap
Medicare Supplement plans, also known as Medigap plans, are plans that cover your cost-sharing expenses with Original Medicare. The Part A deductible and Part B coinsurance are just a couple of examples of what Medigap plans cover.
These plans pay only if Original Medicare pays. Therefore, these plans aren’t for covering non-Medicare-approved services such as dental. These plans are also sold by insurance carriers. However, the only thing different about the plans from each carrier are the premiums. The coverage for each plan is the same, no matter the carrier.
We hope this Medicare guide has made things clearer. Once you understand what each part and plan is for, you will have an easier time figuring out the rest of the Medicare program.