Medicare Basics


There are 4 parts of Medicare:

  1. Part A– Hospital Insurance: Covers inpatient care in hospitals, limited days in skilled nursing facilities, some home health care, and hospice care. The premium is free for most, others must purchase. There is a deductible and co-payments that generally increase each year.
  2. Part B– Medical Insurance: Covers doctor services and outpatient care, other medical services that A doesn’t cover like physical and occupational therapists and some home health care. Most people pay a monthly premium. Requires you to pay a deductible and 20% co-insurance when you receive services.
  3. Part C– Medicare Advantage plans: Private companies provide parts A & B to eligible people who enroll. Many cover prescription drugs. You must still pay the Part B premium. You may need to pay a monthly premium and may have to pay deductible and co-payments when receive care. Special Needs Plans and Medical Savings Accounts are types of Medicare Advantage plans.
  4. Part D– Prescription drug coverage: Private companies contract with Medicare to provide coverage. May require you to pay monthly premium and annual deductible. May also have to make co-payments when get prescriptions.


Medicare Supplement Coverage– Medigap: private health insurance- once you have both A & B, you can apply for this insurance to help pay for things not covered. MedSup are standardized- you can get a chart comparing benefits from an insurance company or at the Ohio Dept. of Insurance. Plans are identified by letters of the alphabet and are identical if they are the same letter even if sold by different companies. No MedSup covers long-term care.


Medicare Advantage Plans– Takes the place of original Medicare and MedSup insurance. Private companies under contract with Medicare sell them. All benefits under original Medicare must be covered and you may get extra benefits like vision and dental. Must have both A & B to enroll.


Prescription Drug Coverage– If you have A or B, you can buy coverage that helps pay prescription costs.  You can enroll in D later without penalty. MedSup sold today doesn’t include prescriptions. If you buy Medicare supplemental policy, you may need to consider a “stand-alone” drug plan in addition. If you choose Medicare Advantage plan, coverage for prescription drugs may be included.


Applying for Medicare– Contact your local Social Security Administration office. You should enroll at least 3 months before your 65th birthday. If you apply during your birth month or the next 3 months thereafter, coverage may be delayed as long as 6 months. (Part A will be retroactive to the first date of your birth month as long as you enroll within 6 months of your 65th birthday. But, Part B will be delayed if you don’t sign up before your birth month. You may need to pay a penalty on Part D if you don’t enroll within 3 months of your birth date. The takeaway is apply early. You cannot purchase a MedSup plan or Medicare Advantage plan until your are first enrolled in Part A & B.

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