The Fundamental Guide to Medicare Parts A, B and C

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Health insurance makes your medical expenses a bit more calculable and affordable. It covers the partial or total cost of a number of services, from regular doctors’ appointments and preventative screenings to emergency room trips and extended hospital stays.

Medicare is a government-run, national health insurance plan that offers coverage to Americans who are at least 65 years old. It is also available to certain younger people who live with specific medical conditions, including end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS/Lou Gehrig’s disease).

When you sign up for Medicare, you get a choice between two options that will determine the way you receive your health coverage and benefits. The two primary options are Original Medicare (Parts, A and B) and Medicare Advantage (Part C).

Original Medicare (Parts A and B)

Original Medicare is the standard health coverage plan. It includes two parts:

  • Part A: Commonly referred to as hospital insurance, Part A helps cover the medical bills for inpatient treatment, nursing facilities, at-home assistance and hospice care.
  • Part B: Commonly referred to as medical insurance, Part B helps cover the cost of outpatient treatment, medical equipment and supplies, preventative screenings, vaccines and many other services from medical professionals.

Typically, there is no premium to pay if you or your spouse has paid Medicare taxes for a minimum of 10 years. This tax is either withheld from your regular paychecks or paid independently if you are self-employed. With Part B, on the other hand, you can expect to pay a monthly premium. If you do not meet the requirements for free Part A and do not wish to pay for it, you simply can pay for Part B on its own. However, you must have Part B in order to purchase Part A. Many people who choose Original Medicare also enroll in a different plan to get Medicare drug coverage (also known as Part D).

Original Medicare covers a large portion of the cost of many medical services and supplies, but it does not cover everything. It is essential to remember that after you match your deductible, you will be expected to pay your share of payments for health care out-of-pocket. To help cover these costs, you can use your insurance from a previous employer, labor union or Medicaid. You can also purchase Medicare supplemental insurance (Medigap) for additional assistance in reducing expenses. Unless you have another form of coverage, there is no limit to what you can pay out-of-pocket annually.

You can visit any doctor or hospital in America that accepts Medicare when you enroll in Original Medicare. After signing up, you will have access to all Original Medicare’s benefits. However, you may choose to join the second Medicare option, a Medicare Advantage plan, instead. You must have both Part A and Part B in order to join.

Medicare Advantage (Part C)

Although most people who sign up for Medicare get their benefits from Original Medicare, others decide to get their health coverage through Medicare Advantage, also referred to as Part C. Medicare Advantage is a plan from a private company that works with Medicare directly and serves as an alternative to Original Medicare for all of your medical and prescription needs.

Unlike Original Medicare, Medicare Advantage plans:

  • usually offer prescription drug coverage (Part D).
  • combine your Part A, Part B and often Part D coverage into a single plan.
  • may provide some additional benefits that Original Medicare does not cover, such as vision and dental care.
  • require that you visit doctors and hospitals that are in the plan’s network only.
  • must include a limit on your out-of-pocket costs for Part A and Part B.
  • do not allow you to purchase or use Medicare supplemental insurance (Medigap).

Even if you choose to join a Medicare Advantage plan, it is important to remember that you still have Medicare. You are still responsible for paying your monthly premiums for Part A (if you are required to) and Part B, and you should still get all of the same benefits that Original Medicare provides. Different Medicare Advantage plans have their own unique sets of rules and restrictions, costs and additional medical benefits. For instance, some plans may or may not cover extra benefits like vision and dental services. Others may require you to pay an additional monthly premium. When choosing and enrolling in a Medicare Advantage Plan, it is important to examine each plan thoroughly to understand the full scope of medical coverage that it offers.

Choosing either Original Medicare or Medicare Advantage will directly affect your medical benefits, monthly premiums, out-of-pocket expenses and which locations you can receive care at. It is paramount that you fully understand every component of your Medicare coverage options so that you can get the health insurance plan that works perfectly with all of your medical needs.

 

Author Bio:  Victoria Jones is a senior Medicare and Health Insurance Writer. Victoria enjoys spending time with family and friends, watching sport.