Part A (Hospital Insurance)

 Helps cover: 

• Inpatient care in hospitals 

• Skilled nursing facility care 

• Hospice care 

• Home health care 

 Medicare Part A provides you hospital insurance at age 65 so long as you or your spouse worked long enough in employment covered by Social Security/Medicare. There usually is no premium deducted from your monthly Social Security payment. 

If you are collecting Social Security, you are automatically enrolled in Part A when you turn 65. If you plan to delay Social Security, you will need to apply for Part A. 

 Helps cover: 

• Services from doctors and other health care providers 

• Outpatient care 

• Home health care 

• Durable medical equipment (like wheelchairs, walkers,  hospital beds, and other equipment) 

• Many preventive services (like screenings, shots or vaccines,  and yearly “Wellness” visits)  

Part B is coverage for anything done in an outpatient setting, like doctors’ services and tests, outpatient care, home health services, durable medical equipment, and other medical services unless you pay for private insurance . Just like Part A, you will be enrolled automatically if you are collecting Social Security but will need to apply if you delay Social Security.

Most people will pay a part B monthly premium, so you might want to delay this coverage if you are keeping an employer plan. If you are a lower income earner you could pay less and if you are a higher income earner you could pay more.  The premium amount that is deducted from your monthly social security payment depends on your total income. For most retirees this deduction from monthly social security is modest ( $174.70 for 2024).  Additionally, the premium can change from one year to the next.

You’ll want to review this option carefully because there are penalties for delaying Part B if your existing coverage is not does not meet Medicare standards.

 If you only have Part A and Part B, you have what is known as Original Medicare.  

 A Medicare Advantage Plan is another way to get your Medicare Part A  and Part B coverage. Medicare Advantage Plans, sometimes called “Part C”  or “MA Plans,” are Medicare-approved plans offered by private companies  that must follow rules set by Medicare. Most Medicare Advantage Plans  include drug coverage (Part D) and some plans may provide even more benefits that are not covered under Original Medicare such as hearing, vision, and dental. 

In many cases, you’ll need to use health  care providers who participate in the plan’s network. These plans set a limit  on what you’ll have to pay out-of-pocket each year for covered services.  Some plans offer non-emergency coverage out of network, but typically at  a higher cost. In many cases, you may need to get approval, also called prior  authorization, from your plan before it covers certain drugs or services. 

Medicare Advantage plans also have a cap on your yearly out-of-pocket costs, while Original Medicare does not. Enrolling in Part C is a great way to keep your costs for health care services from piling up. 

 Who can join?

To join a Medicare Advantage Plan you must:  

• Have Part A and Part B.  

• Live in the plan’s service area.  

• Be a U.S. citizen or lawfully present in the U.S. 

Helps cover the cost of prescription drugs (including many  recommended shots or vaccines). 

Plans that offer Medicare drug coverage (Part D) are run by  private insurance companies that follow rules set by Medicare.

Original Medicare does not include a drug benefit, and that’s where Medicare Part D steps in, covering specific generic and brand name drugs included in the list of covered drugs. This list is also referred to as the formulary and each plan has its own formulary. 

 Though Medicare Part D is available as a standalone plan, many Medicare Advantage plans include Part D in their coverage. 

 Original Medicare doesn’t pay for all of the cost for covered health care  services and supplies. Medicare Supplement Insurance (Medigap) policies  sold by private insurance companies can help pay some of the remaining  health care costs for covered services and supplies, like copayments,  coinsurance, and deductibles.  

Some Medigap policies also offer coverage for services that Original  Medicare doesn’t cover, like medical care when you travel outside the U.S.  Generally, Medigap doesn’t cover long-term care (like care in a nursing  home), vision or dental services, hearing aids, eyeglasses, or private-duty  nursing. 

 Plans offering additional benefits; payable to consumers based upon their medical utilization; sometimes used to defray copays/coinsurance. These plans are not affiliated or connected to Medicare. 

 Plans offering additional benefits for consumers who are looking to cover needs for dental, vision or hearing. These plans are not affiliated or connected to Medicare. 

 Sometimes called critical illness insurance—offers a financial payout to people with one of these health issues. 

If you suffer a heart attack, cancer or stroke, this insurance provides a cash benefit that you can use in any way you choose. 

 This type of supplemental health insurance pays out a lump sum to the policyholder, who can use the money to pay for various expenses.