Medicare and it's Oh so many parts...
Updated: Nov 4, 2022
With the end of Medicare's annual open enrollment period just around the corner, December 7th, let’s go into the complexities of Medicare by discussing what each part is and means. If you know of an individual or you are someone who has the pleasure of exploring Medicare options, you likely have been faced with utter confusion as to what you need and what each Part means.
Medicare Part A – Part A is administered through CMS and covers hospitalization, skilled nursing, nursing home care (if not custodial), hospice and home health care after a deductible of $1,340. Beneficiaries will have the Part A benefit at no cost should they or their spouse pay in the appropriate amount of Medicare taxes while working. If the beneficiary, or spouse, did not pay into Medicare while working, they may qualify for Medicare Part A if they are 65 or older, meet the citizenship/residency requirements and pay $422 per month in premiums (2018).
Medicare Part B – Part B is administered through CMS and covers physician services, durable medical equipment, ambulance, mental health and a limited prescription benefit typically administered through a physician. The Part B benefit will begin to payout 80% of the cost after a deductible of $183 is paid by the beneficiary. The premium for Part B is determined based on income level and will be between $134 and $428.60 per month.
Medicare Part C – Otherwise known as Medicare Advantage, this plan is administered through insurance carriers and will vary greatly in benefit and premium amounts. The benefit requires the beneficiary to be enrolled in Medicare Parts A and B but will actually take the place of the benefits at the provider level. Premium levels range anywhere from $0 to $375 per month, depending on plan design and geographic location. These plans will typically include a prescription benefit but not always. The plans may or may not have a network of physicians you will be required to use along with plan deductibles and copays.
Medicare Part D – Otherwise known as Medicare Prescription Part D, this plan is administered through insurance carriers and will vary greatly in benefit and premium amounts. To qualify, the beneficiary must be enrolled in Medicare Parts A and B. Premiums range from $10 to $200, depending on geographic region, plan design and carrier. The beneficiary will typically enroll in the Part D benefit if they are enrolled in a Medicare supplement plan or a Part C program that does not include a prescription benefit. Most plans will contain a deductible and various limits based on cost.
Medicare Supplement Plans A - N – Supplement plans are meant to supplement Medicare Parts A and B. They typically cover the costs that Medicare Parts A and B do not, with a variance in the level of coverage by the corresponding supplement. Rates will vary by age, plan design, carrier and geographic region. While this benefit provides the most comprehensive coverage with the least limitations on provider access, it is also considered the most costly. The rates vary significantly by age and area, and the beneficiary can be denied coverage due to a medical condition. Also, there is no prescription benefit attached to the supplement options.
These are just some of the basics for Medicare. If you or someone you know is interested in learning more please feel free to reach out. www.MonarchBA.com
John J. Marchetti