Medicare Parts A, B and C
WHAT IS MEDICARE PART A?
Medicare Part A is generally referred to as “hospital insurance.” It is half of Original Medicare, together with Medicare Part B.
Medicare A-C Glossary
Original Medicare: Original Medicare is comprised of Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance).
Deductible: The amount you must pay for health care or prescription drugs before other insurance (Original Medicare, a Medicare Advantage Plan or Part D drug plan, or other insurance) begins to pay part or all of costs.
Coinsurance: An amount, usually a percentage of total costs, you may be required to pay as your share of the cost for services after meeting your plan’s deductible.
Copayment: An amount you may be required to pay for covered procedures, medications, and other medical costs after meeting your plan’s deductible.
Premium: The periodic payment to Medicare, an insurance company, or a health plan for medical or prescription coverage.
Preventive Care: Health care to prevent illness or detect it at an early stage.
Medically Necessary Services: Services or supplies needed to diagnose or treat an illness, injury, condition, or disease. Services must meet accepted standards of medicine to be considered medically necessary.
Durable Medical Equipment: Medical equipment, such as a wheelchair or hospital bed, that’s ordered by a doctor for use in the home.
How do I know Original Medicare is right for me? Learn more.
MEDICARE PART A COVERAGE AND COSTS
Each part of Original Medicare includes costs such as deductibles and coinsurance payments.
What Does Medicare Part A Cover?
Medicare Part A generally covers the following:
- Hospital inpatient care
- Skilled nursing facility care
- Nursing home care
- Hospice care
- Home health care
Some services may only be covered for patients with certain conditions. It’s important to know that if you’re in a Medicare Advantage plan or another Medicare plan, your plan may have different rules.
If you’re not sure whether Medicare covers your care, services or supplies, talk to one of our licensed team members.
Read: What Is Medicare Part A and What Does it Cover?
Depending on your circumstances, there may or may not be a monthly premium for Medicare Part A. If you or your spouse has worked in the United States for a certain period of time, you will not have to pay a premium. In addition, if you are already receiving Social Security retirement or disability benefits, you will likely qualify for premium-free Part A.
Is There a Late Enrollment Penalty for Medicare Part A?
If you are eligible for Part A but don’t sign up right away, you may have to pay a late enrollment penalty. Your monthly premium could go up by 10%, and you’ll have to pay that higher premium for twice the number of years you didn’t sign up.
Read: Do I Have to Sign Up for Medicare if I Don’t Retire at 65?
WHAT IS MEDICARE PART B?
Medicare Part B is the other half of Original Medicare. Part B covers preventive care, and is therefore commonly referred to as “medical insurance.”
Medicare Part B covers two types of services:
- Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition, and that meet accepted standards of medical practice.
- Preventive services: Health care to prevent illness or detect it at an early stage, when treatment is most likely to work best.
MEDICARE PART B COVERAGE AND COSTS
Medicare Part B can be categorized as medical insurance. It may cover items such as clinical research, ambulance services, durable medical equipment (DME), mental health, and limited outpatient prescription drugs. Part B costs are dependent on a couple different factors.
Your base premium is a monthly payment that is determined by your income. After you pay your deductible for the year, you will typically pay 20% of the Medicare-approved amount for:
- Doctor services
- Outpatient therapy
- Durable Medical Equipment (DME)
Read: Will Original Medicare Meet my Coverage Needs?
NOTE: Part B has a premium which can vary by your gross income from two years prior – so 2020 income would affect 2022 Part B rates.
Is There a Late Enrollment Penalty for Medicare Part B?
If you are eligible for Part B but don’t sign up right away, you may have to pay a late enrollment penalty. Your monthly premium could go up by 10% for each 12-month period you did not sign up when eligible. Therefore, the longer you go without Part B coverage the greater your penalty would be. You would then have to pay this penalty for as long as you have Medicare Part B.
How Do I Enroll in Medicare? Learn More.
WHAT IS MEDICARE PART C?
One way to receive Medicare Coverage is by enrolling in Medicare Part C, or a Medicare Advantage Plan. Medicare Advantage Plans, often called Part C or MA Plans, are offered by private insurance companies approved by Medicare.
MEDICARE PART C COVERAGE AND COSTS
Medicare Part C is a private Medicare plan that provides all benefits of Medicare Parts A and B, or Original Medicare. Most commonly called a Medicare Advantage Plan, Part C plans often include Part D drug coverage. When you have Part C, you will continue to pay your part B premium. (Note: Medicare Advantage Plans are not Medicare Supplements (Medigap).)
Read: Medigap – What Is It and Do I Need It?
These plans provide coverage for your approved Medicare Part A (hospital) and Part B (medical) coverage. A Medicare Advantage Plan must provide all benefits of Original Medicare, and have a cap on out-of-pocket costs.
Read: Frequently Asked Questions About Medicare Advantage Plans
In addition to Part A and Part B coverage, Medicare Advantage Plans may cover the following:
- Dental Coverage
- Vision Coverage
- Hearing Coverage
- Medicare Part D Drug Coverage
Common types of Part C plans include:
- Preferred Provider Organizations (PPO)
- Health Maintenance Organizations (HMO)
- Private Fee-For-Service Plans (PFFS)
- Special Needs Plans (SNP)
- Medical Savings Account plans (MSA)
Ultimately, a Medicare Advantage Plan can include as much or as little as you need it to. Many Medicare Advantage Plans have a network of contracted providers and facilities. It’s important to understand how the network functions, and to be sure the plan you choose contracts with the providers you want to use. MA Plans typically provide urgent care and emergency coverage both inside and outside the plan’s coverage area.
Read: Should I Get Medicare Advantage or Medigap?
When you enroll in a Medicare Advantage Plan, The Centers for Medicare and Medicaid Services (CMS) will send a flat monthly rate to the insurance companies while you are enrolled in their plan. That money is sent whether you have claims or not.
We’re Here to Help!
Get all the answers to your Medicare questions in our Medicare Resource Guide.
Do you have questions about Medicare, and which plan is right for you? Twin City Underwriters offers free informational Medicare webinars and one-on-one consultations with agents where you can ask questions and get personal answers. We can help you select the right coverage for your needs. To attend a webinar or set up an appointment, call us toll free at 1-800-507-6778 or send us a message.
