Medicare is a massive federal health insurance program developed in the 1960s meant to service the elderly populations in the United States and assist with their healthcare costs as they age. As of 2017, the governmentspends more than $700 billionevery year on Medicare, and more than 55 million citizens—most of them elderly—receive benefits from Medicare.
Knowing the ins-and-outs of Medicare can be confusing. How much will you pay per month? What doctors can you see? How do you enroll? What does each part of the program cover? Let’s answer these questions, starting first with what exactly Medicare is and who it covers.
What is Medicare
Medicare is a program meant to assist with healthcare for the following demographics:
Overall, Medicare covers hospital costs, visits to the doctor, prescriptions, nursing home care, second opinions, and medical equipment
- Elderly people 65 and over
- People who become disabled before 65 (in this instance, you must be collecting Social Security Disability Insurance, which we’ll discuss more when talking about enrolling in Medicare)
Medicare coverage is split up into four main parts. Overall, Medicare covers hospital costs, visits to the doctor, prescriptions, nursing home care, second opinions, and medical equipment. But Medicare isn’t completely free. Everyone pays a different rate depending on the type of coverage they get.
Part A
The first section of Medicare concerns inpatient care costs. These can include a range of services like hospital stays, nursing home care, and hospice care.
Part A is one of the three primary parts of Medicare that details every facet of healthcare that the program covers. The remaining parts—those beyond A, B, and D—are variations on different plans for different kinds of people who qualify, but typically carry some form of combination of Part A, B, and D. We’ll discuss that more later.
Every one of the 55 million-pluspeople who have Medicare have part A under their plan.
It’s easy to say that Part A of Medicare covers all “inpatient care” costs, so let’s dig into the details of what that means exactly. These services include:
- Emergency room care
- Stays at a standard hospital
- Mental healthcare
- Physical and occupational therapy at home
- Long-term stays at hospitals
- Certain medical equipment needed at home (if it’s bought by your doctor and deemed necessary)
- Doctor and nurse care at a hospice facility
- Care at an inpatient rehab facility
Health coverage under Medicare can change every year, so stay in contact with your insurance provider to make sure the services under part A you need are covered. Nevertheless, there is still a large list of services that are covered by Medicare at any point. You can find out if what youneed is covered here.
There is no premium for Part A services. There are some costs that may arise from lengthy hospital and “skilled nursing facility” stays. You can find thesecosts detailed here.
| If your yearly income in 2016 was | You pay (in 2018) | ||
| File Individual Tax Return | File joint tax return | File married & separate tax return | |
| $85,000 Or Less | $170,000 or less | $85,000 or less | $134 |
| Above $85,000 Up To $107,000 | above $170,000 up to $214,000 | not applicable | $187.50 |
| Above $107,000 Up To $133,500 | above $214,000 up to $267,000 | not applicable | $267.90 |
| Above $133,500 Up To $160,000 | above $267,000 up to $320,000 | not applicable | $348.30 |
| Above $160,000 | above $320,000 | above $85,000 | $428.60 |
| If your yearly income in 2016 was | You pay (in 2018) |
| File Individual Tax Return | File joint tax return | File married & separate tax return |
| $85,000 Or Less | $170,000 or less | $85,000 or less | $134 |
| Above $85,000 Up To $107,000 | above $170,000 up to $214,000 | not applicable | $187.50 |
| Above $107,000 Up To $133,500 | above $214,000 up to $267,000 | not applicable | $267.90 |
| Above $133,500 Up To $160,000 | above $267,000 up to $320,000 | not applicable | $348.30 |
| Above $160,000 | above $320,000 | above $85,000 | $428.60 |
Part B
Where Part A covers healthcare costs concerning inpatient services in hospitals, nursing homes, and other places, Part B covers outpatient services. Services covered by Part B include:
- Visits to specialty doctors
- Preventative services like flu shots, vaccines, or anything that detects an illness “at an early stage”
- Supplies needed to treat medical conditions. These supplies must “meet accepted standards of medical practice”
- Ambulance rides and care
- Getting opinions from another doctor before having surgery
- Participation in clinical research
Unlike Part A, not everyone who has Medicare also has Part B services—largely because there are monthly premiums you will need to pay for Part B.
Unlike Part A, not everyone who has Medicare also has Part B services—largely because there are monthly premiums you will need to pay for Part B. Still, more than 52 million people (above 90 percent of those who could have it) have Part B services as a part of their Medicare plan.
The average premium for someone who made less than $85,000 in a year or $170,000 in a joint filing tax return (according to your last tax filing) is $134 per month, according to theMedicare website. This number can decrease if you’re receiving Social Security benefits or it can increase if you made more than $85,000 in the previous year. There is also a $183 yearly deductible.
These costs may also be higher if you choose to not enroll in Part B services initially but want to enroll in them at a later date. Your premium will be 10 percent higher for every 12 months you aren’t enrolled in Part B.
For example:
If after two and a half years (30 months), you decide you want to enroll in Part B services and you’re still making less than $85,000 a year, your premium will jump from what could’ve been $134 a month up to more than $162 a month.
Part B premiums are automatically deducted from Social Security benefits.
Part C
At its core, Medicare is a simple system that you automatically qualify for by turning 65, where you pay small premiums to help cover most if not all of your medical costs to help ease the financial burden as you age. But after Part A and B, Medicare can begin to get a little confusing. But don’t worry, because we’re here to break down all the other parts of Medicare to help you choose and understand each plan.
Part C is an option for elderly people already enrolled in Part A and B. Part C is an additional private insurance plan that covers services like vision, dental, and usually prescriptions. (We’ll discuss these more in a moment.)
These plans are called Medicare Advantage plans. You will pay a premium with the private insurance company for the additional services as well as your premium for Part B.
Private plans included in Part C coverage are:
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Special Needs Plans (SNPs)
- Medical Savings Accounts (MSAs)
- HMO Point-of Service plans (HMOPOS)
You may add a Part C plan to your existing Medicare coverage because it opens up the kinds of doctors you can visit, the coverage you get, and the prescriptions that are paid. Adding Part C to your plan almost always costs more money, though. Despite this, more than 17 million elderly people enroll in Part C services.
It’s difficult to estimate the average cost of a Part C plan; factors like where you live and how long you’ve had Medicare come into play. But you can visit theMedicare websiteto get a rough estimate.
Part D
Part D adds prescription drug coverage to your Medicare plan.
Unlike Part A and B, you will need to enroll with a private insurance company approved by Medicare to get your prescriptions. Because of this, there will be a premium on your prescriptions, like Part B.
The average monthly premium (as of 2017) for prescriptions was $34.
The average monthly premium (as of 2017) for prescriptions was $34. Some companies will also charge a deductible (no more than $400 in a year), meaning they won’t pay for your prescriptions until the deductible is met. But there are also many insurance companies that offer plans with zero deductible, meaning all you will have to pay is the premium.
This is an extremely beneficial cost for the elderly. Nearly90 percent of seniorsneed at least one prescription a month, and more than one-third take five or more prescriptions medications per month.
More than 43 million people have Part D as a part of their plan. Some people don’t have Part D drug coverage because they may be getting it from their Part C Medicare Advantage plan. There is a late-enrollment fee—like Part B—if you choose to enroll in Part D coverage later down the road.
Supplemental Insurance (Medigap)
Here is where private insurance companies start to flood Medicare. As we saw in Part C, there are options to get health insurance from private companies. You pay a premium and/or deductible with those companies on top of your premium for Part B.
You can acquire additional— or supplemental— insurance to help pay many of if not all of the deductibles and extra charges that come with Parts A through D of Medicare. These are calledMedigapplans.
Medigap plans help pay for things like copayments, coinsurance, and deductibles—all things standard Medicare plans don’t cover.
Medigap plans help pay for things like copayments, coinsurance, and deductibles—all things standard Medicare plans don’t cover. They also cover some extra services not usually covered by Medicare.
These supplemental plans make it so that you have low out-of-pocket costs while raising your monthly premium. This is different from Part C of Medicare (the Medicare Advantage Plan), which typically has thousands of dollars worth of deductibles with lower monthly premiums. Supplemental plans will also allow you to have a wider range of doctors and services to choose from at the cost of a higher up-front monthly payment.
In order to get any of these following plans,you must have Part A and B of Medicare.
Available Medigap plans are: A, B, C, D, F, G, K, L, M, and N. Each plan covers a varying amount of deductibles, coinsurance payments, copayments, and other medical costs.
The most popular plan is Plan F.Two-thirds of the 13 million-pluspeople who get Medigap insurance get Plan F. It’s also the most expensive plan, because it covers the most amount of extra payments, including the premiums and coinsurances for part A and B for Medicare, hospital stays for up to 365 days after Medicare doesn’t pay for them anymore, foreign travel insurance, and more.
Medicare Supplement Insurance (Medigap): When Medicare doesn’t cover those medical expenses, thankfully there is Medicare Supplement Insurance, which is commonly referred to as “Medigap.”
Enrolling In Medicare
You are automatically eligible for Medicare the day you turn 65 if you are already receiving Social Security or disability benefits.
Typically, you fill out Medicare information—what plan you’re getting, where your Medicare card will be sent to—when you apply for Social Security. You can still be eligible for Medicare if you aren’t eligible for Social Security. If this is the case, you may have a premium attached to Part A of your Medicare coverage.
You can enroll in Medicare over a seven-month period that starts three months before your 65th birthday—so three months before and four months after. This is called the Initial Enrollment Period. If you don’t apply for Part B of Medicare in this time, then there could be late enrollment penalties should you eventually want Part B.
If you choose to receive Medicare before you start to receive Social Security and are within a couple months of turning 65, the process to apply for Medicare is still very easy and can be done by visiting the Social Security website or your local Social Security office.
If you have any questions regarding Medicare, billing, or what plan you currently have, contact the federalMedicare office.
- Was this Article Helpful ?
- YesNo
Do you want to cite this page? Use our ready-made cite template.
