If you are interested in applying for Medicare, it is important to first review the coverage options that are available through Medicare health insurance, as well as the out of pocket costs that you can expect.
Medicare allows you to create your own plan in order to build your level of coverage. This health insurance is split into four different sections: Parts A, B, C and D.
Each part of Medicare includes a different level of coverage. For example, Medicare Part A provides coverage for hospital care and hospice care, while Medicare Part B provides a more general coverage. Medicare Part D provides prescription drug coverage, while Part C provides an array of coverage options and is often considered the hybrid of other forms of Medicare.
Finally, when considering the cost of Medicare health insurance, it is important to review whether or not you might also be eligible for Medicaid. Should you be found dually eligible, you may be able to receive additional coverage, as well as assistance in paying the cost of your Medicare. To learn more about Medicare costs and coverages, review the information below.
Learn About Medicare Part A
Medicare Part A, commonly referred to as hospital insurance, is the only part of Medicare that is often free to Medicare recipients. Generally, Medicare Part A includes:
- Hospice care.
- Skilled nursing facility care for up to 100 days.
- Inpatient hospital care.
- Home health services.
While Medicare Part A may not include as much as other parts of Medicare, you are eligible to receive Medicare without a premium at age 65 as long as:
- You receive retirement benefits from either the Railroad Retirement Board (RRB) or the Social Security Administration (SSA).
- You are eligible to receive Social Security or RRB benefits, but you have not yet filed for them.
- You or your spouse was previously employed by a Medicare-covered government employer.
If you are younger than 65 years of age, you can still get Medicare Part A for free as long as you have received Social Security or Railroad Retirement Board (RRB) disability payments for a minimum of 24 months or have End-Stage Renal Disease (ESRD) and meet additional requirements.
If you do not meet Medicare requirements for Part A, you can purchase Part A by opting to pay monthly premiums. Your premium amount will depend on the amount of tax quarters you have paid into Medicare. The average cost of Medicare Part A premiums is between $232 and $422 monthly. However, you may receive a higher premium cost if you became eligible for Medicare Part A and chose not to enroll during your initial enrollment period.
It is also important to be aware that you will have a deductible for inpatient hospital stays as well as a coinsurance that starts at $335 per day of each benefit period starting day 61.
Learn About Medicare Part B
Medicare Part B provides a larger range of coverage, as it typically includes medically necessary services as well as preventative services. Medicare Part B coverage includes medical services such as:
- Visits with a physician
- X-ray services and laboratory work
- Ambulance services
- Durable medical equipment (DME)
- Mental health services, including inpatient, outpatient and partial hospitalization
- Preventative services
Medicare Part B includes monthly premium charges, co-insurance payments and deductibles that must be met before Medicare will begin to provide coverage. While the standard premium for Medicare Part B is $134, if you are receiving Social Security benefits, you may pay less for your monthly premium. However, if your income is relatively high, you may pay a higher premium. Additionally, Medicare Part B includes a $134 deductible that must be met before Medicare will pay 80 percent of approved medical services. Similarly to Medicare Part A, you may have a higher premium for Medicare Part B if you missed your initial enrollment period, unless you qualified for a special enrollment period.
Learn About Medicare Part C
While Medicare Part A and Part B are referred to as original Medicare, Part C offers hybrid plans that offer aspects of Part A, Part B and Part C. These plans differ a little by provider and the area that you live in, but they generally include the coverage that is provided in both Part A and Part B. In addition to this coverage, some Medicare Part C plans will include coverage that is not offered as part of Part A or Part B plans, including:
- Dental services.
- Hearing services.
- Vision services.
In some cases, Medicare Part C may also include prescription drug plans so that you need not purchase Medicare Part D.
Medicare Part C involves monthly premiums and, in most cases, deductibles and co-insurance payments. However, the amounts that you would be expected to pay will depend on the plan that you select. As mentioned previously, the plans that are available to you will depend on where you live.
Learn About Medicare Part D
Medicare Part D is an optional form of Medicare coverage that you can purchase to accompany your original Medicare (Part A and Part B). It can also be added to Medicare Part C plans that do not include prescription drug coverage.
Medicare Part D solely provides prescription drug coverage to Medicare beneficiaries. It does not provide any coverage for medical services beyond drug coverage, but there are a variety of plans that you can choose from in order to ensure that you choose a plan that will include the medications that you take. Like Medicare Part A and Part B, you may have a higher premium for Medicare Part D if you were eligible for Part D previously but chose not to enroll or missed your initial enrollment period.
Find Out About Medicare, Medicaid and You
It is estimated that 8.3 million individuals who are eligible for Medicare are also eligible to receive Medicaid benefits. This is considered “dual eligibility” and serves to provide greater coverage and lower costs to low-income Medicare recipients. In some cases, state Medicaid programs include prescription drug, vision services, dental services and hearing services.
If you are eligible to receive coverage from both programs when you complete the application process for Medicare, you will gain all of the coverage that your state’s Medicaid program has to offer. Additionally, Medicaid can help you pay for out of pocket costs for your Medicare coverage including deductibles and copayments.