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MEDICARE PART A

Medicare Part A covers hospital stays and inpatient care. In general, Part A covers:

  • Inpatient care in a hospital
  • Skilled nursing facility care
  • Nursing home care (inpatient care in a skilled nursing facility that's not custodial or long-term care)
  • Hospice care
  • Home health care

You may have to pay various deductibles, coinsurance, and copayments if you are not enrolled in a Medicare supplement plan or Medicare Part C plan.

If you are 65 and you or your spouse paid Medicare taxes for at least 10 years, you will not have to pay a premium for Medicare Part A. You may also not have to pay a premium if:

  • You haven't reached age 65, but you are disabled and have been receiving Social Security benefits or Railroad Retirement Board disability benefits for two years.
  • You have end-stage renal disease (ESRD) and are receiving dialysis, and either you or your spouse or parent (if you’re a dependent child) worked and paid Medicare taxes for at least 10 years. Coverage typically begins the first day of your fourth month of dialysis, but it can begin in your first month of dialysis if you use in-home dialysis treatment.
  • You have amyotrophic lateral sclerosis (ALS) and are eligible for Social Security Disability Insurance (SSDI). Medicare coverage begins as soon as your SSDI begins, and Medicare Part A has no premiums if you or your spouse (or parent, if you’re a dependent child) worked and paid Medicare taxes for at least 10 years.
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MEDICARE PART B

Part B covers thins like:

  • Clinical research
  • Ambulance services
  • Durable medical equipment (DME)
  • Mental health (Inpatient, outpatient, and partial hospitalization)

You pay a premium each month for Part B. Your Part B premium will be automatically deducted from your benefit payment if you are receiving:

  • Social Security
  • Railroad Retirement Board
  • Office of Personnel Management

If you are not receiving one of the benefit payments above, you will be billed for Part B.

 

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MEDICARE ADVANTAGE
Also called Part C

Combines Part A (hospital), B (doctors) and most Medicare Advantage plans also include Part D (prescriptions).

In many areas, $0 monthly premium plans are available. No need to pay money for Medicare Supplement or Part D plan.

Medicare Advantage plans also include extra benefits such as:

  • Dental and Vision
  • Hearing
  • Fitness programs
  • Insulin Savings Program
  • Personal Emergency Response System (I’ve fallen, and I can’t get up)
  • Foot care
  • Over-the-Counter (OTC) products such as toothpaste, pain relief, vitamins, incontinence products, safety grab bars, cough drops and more.
  • 24-hour Nurse Line / Telehealth coverage
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MEDICARE PART D
Also called Prescription Drug Plans or PDPs

Part D is an optional prescription drug coverage plan that covers medications.

Although Medicare Part D coverage is optional, it is a very valuable cost saver if you take medications.

Most Medicare Advantage plans include Part D coverage, therefore enrollment in stand-a-lone Medicare Part D plan is not required.

Each PDP has its own list of covered drugs (called a formulary). Drugs are placed into a “tier” on the formularies and each tier has a different cost. The lower the tier, the less the drug will cost.

Note: If you do not enroll in a Part D pan when you become eligible for Medicare and you do not have creditable drug or Medicare Advantage coverage, you will be assessed a late enrollment penalty equal to about 1% of the average monthly premiums for each month you delayed enrollment. The penalty must be paid as long as you are enrolled in a Part D.

 

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MEDICARE SUPPLEMENT
Also called Medigap

A Med Supp or Medigap Plan helps to pay some of the cost that Medicare Part A and B do not, like coinsurance, copayments, or deductibles.

There are no provider networks with Medicare Supplement pans. Plans can be used with any doctor or hospital that accepts Medicare.

Note: Generally, these plans don’t cover long-term care (like care in a nursing home), vision or dental care, hearing aids, private duty nursing or prescriptions drug plans.