We’ve all heard of Medicare, but what does that entail? Do you know the difference between all Medicare plans? If you don’t, you’re not alone. Currently, around 15% of the U.S. population is covered by Medicare. Enrollment is expected to approach 45% of the population by 2030.
Not sure of what Medicare plan you own or how it can help you? You’re not alone. The four different plans are a little confusing, but choosing the right one can help save you money and provide you with the coverage you need. Here’s a quick guide to help you differentiate between the different plans and choose the right type of coverage for your needs.
What Is Medicare?
Medicare is a government-run health insurance program for people over the age of 65 or for those who have disabilities. It helps to cover some of the costs associated with medical care, including doctor’s visits, hospital stays, and prescription drugs.
There are four different plans under Medicare: A, B, C, and D. Each plan has its own specific coverage and benefits. Let’s break down each one.
Medicare Plan A
Medicare Plan A is the basic plan offered by Medicare. It covers hospital stays, doctor’s visits, mental health care, and some home health care. It does not cover prescription drugs, preventive services, or dental or vision care.
Eligibility for Medicare Plan A depends on your income and whether you have worked long enough to qualify for Medicare. Generally, people who are 65 or older and have paid into Social Security for at least 10 years are eligible for Medicare Plan A.
Services Covered By Plan A
Medicare Plan A covers a variety of services, including:
Hospital stays: Hospital stays are covered when you’re admitted by a doctor as an inpatient. The amount of time you can stay in the hospital covered by Medicare Plan A depends on the hospital.
Doctor visits: You’re covered for one doctor visit per month. This includes a primary care doctor and specialist visits, but not chiropractors, dentists, or optometrists.
Skilled Nursing Facility Care: This includes care in a nursing home after you’ve been hospitalized but before you go home.
Mental health care: This includes visits to a psychiatrist, psychologist, or other therapists.
Home health care: You can get up to 100 hours of coverage each year for services like physical therapy, speech-language therapy, and occupational therapy.
What Does It Not Cover?
Medicare Plan A does not cover:
- Prescription drugs
- Vision or dental care
- Preventive services such as screenings and checkups
What Are the Costs for Plan A?
If you or your spouse worked for a certain number of years and paid Medicare taxes, you may not have to pay a monthly premium for Medicare Part A (Hospital Insurance) coverage. This is known as “premium-free Part A.” The majority of people make use of premium-free Part A.
Over 65
If you’re over 65, you’re eligible for premium-free part A if you already receive Social Security or Railroad Retirement Board retirement benefits. You are qualified to claim Social Security or Railroad benefits but have not done so yet. You had Medicare-covered employment under the federal government.
Under 65
If you’re under 65, you may be eligible for premium-free Part A if you’ve received social security or railroad retirement board disability payments in the last 24 months. You can also be eligible if you have end-stage renal disease and meet certain criteria.
Part A Premiums
You can buy part A as a premium if you don’t qualify for the premium-free. The cost of Part A premium as of 2022 can vary from $274 to $499 per month.
Medicare Part B
Medicare Plan B is a more comprehensive plan that covers prescription drugs, preventive services, dental care, and vision care. It also covers some of the costs associated with hospital stays and doctor’s visits.
Eligibility for Medicare Plan B also depends on your income and work history. People who are 65 or older and have paid into Social Security for at least 10 years are usually eligible for this plan. However, people under the age of 65 can also qualify if they have a disability or are on Social Security Disability.
What Does Medicare Plan B Cover?
Each Medicare plan offers specific benefits and coverage. Medicare Plan B covers:
Prescription drugs: This includes both prescription and over-the-counter drugs.
Preventive services: This includes screenings and checkups for conditions like cancer and heart disease.
Dental care: You’re covered for two dental cleanings, routine exams, and X-rays per year.
Vision care: You’re covered for one vision exam every 12 months and for glasses or contacts every 24 months.
Hospital stays: The plan covers part of the costs associated with a hospital stay, depending on the type of hospital you’re in.
Doctor visits: You’re covered for one doctor visit per month. This includes a primary care doctor and specialist visits, but not chiropractors, dentists, or other practitioners.
Mental health care: The plan covers visits to a psychiatrist, psychologist, or other therapists.
What Is Not Covered by Plan B?
Some things are not covered by Medicare Plan B, including:
- The costs of premiums and deductibles
- Care outside of the U.S.
- Most long-term care services
How Much Does Medicare Plan B Cost?
Similar to Plan A, some people can acquire Medicare Plan B automatically. However, those who aren’t can sign up. If the sign-up period is missed when you’re available to apply, you may need to pay a late enrollment fee.
The premium for Plan B usually costs more than Plan A. The monthly premium varies depending on your income, but it is typically around $170.10 per month (as of 2022). You may also have to pay a deductible and co-pays for services.
Premium
To get Part B premium, you must pay each month. However, if you already have some of these benefits, they will be deducted from your Plan B premium payment:
- Office of Personnel Management (OPM Benefits)
- Social Security
- Railroad Retirement Board
What Is Medicare Plan C?
Medicare Plan C, also known as Medicare Advantage, is a plan that offers additional coverage for people who want more comprehensive health insurance. It covers prescription drugs, preventive services, hospital stays, doctor’s visits, and mental health care. It also includes coverage for some home health care and outpatient services.
Eligibility for Medicare Plan C also depends on your income and work history. You must be enrolled in both Medicare Plans A and B to be eligible.
What Does Plan C Cover?
Medicare Plan C covers various services, including:
Prescription drugs: This includes both prescription and over-the-counter drugs.
Preventive services: This includes screenings and checkups for conditions like cancer and heart disease.
Hospital stays: The plan covers part of the costs associated with a hospital stay, depending on the type of hospital you’re in.
Doctor visits: You’re covered for one doctor visit per month. This includes a primary care doctor and specialist visits, but not chiropractors, dentists, or other practitioners.
Mental health care: The plan covers visits to a psychiatrist, psychologist, or other therapists.
Outpatient services: The plan covers services like physical therapy, lab tests, and X-rays.
Home health care: The plan covers some home health care services, like visits from a nurse or therapist.
What Isn’t Covered Under Plan C?
Some things are not covered by Medicare Plan C, including:
- The costs of premiums and deductibles
- Care outside of the U.S.
- Most long-term care services
How Much Does Medicare Plan C Cost?
Medicare Advantage (Plan C) cost varies depending on your location. Normally, these premiums are lower than what you pay for Medicare Plan B, going as low as $0 and as high as $200 for Medicare Advantage. However, you still need to pay Plan B fully, although some Advantage plans can help out with the cost.
What Is Medicare Plan D?
Medicare Plan D is a prescription drug plan offered by Medicare. It helps to cover the costs of prescription drugs. Eligibility for Medicare Plan D depends on your income and whether you have worked long enough to qualify for Medicare. Generally, people who are 65 or older and have paid into Social Security for at least 10 years are eligible for Medicare Plan D.
What Does Medicare Plan D Cover?
Medicare Plan D covers most of the costs for prescription drugs. This includes both prescription and over-the-counter drugs. It also includes drugs that are not covered by Medicare Plans A and B.
What Is Not Covered by Medicare Plan D?
There are some things that are not covered by Medicare Plan D, including:
- The costs of premiums and deductibles
- Care outside of the U.S.
- Most long-term care services
How Much Does Medicare Plan D Cost?
Drug coverage varies and depends on the plan you have in place. This is paid in addition to Plan B. If you have a high income (over $87k individually or $174k joint), You’ll have to pay extra in addition to your premium. This also needs to be paid if you already have Medicare Advantage with drug insurance. However, most people won’t have to do it, as it’s not applicable to everyone.
Social Security will let you know if you have to pay extra depending on your income. Similar to Plan C, Plan D will charge a late fee if you don’t sign up for it when you’re first available to apply for it.
Let Us Help You Choose The Best Plan For You
At Nesso Group, we can help you find the plan that will best fit and cover your needs. We’ll walk you through every step of the process and maintain open communication, so you’re able to make an informed decision with all the information available.
With Nesso Senior Benefits, you won’t have to worry about missing information. Our team of Medicare plan advisors will ensure every detail is up to date. Don’t hesitate to reach out now so we can get started on selecting the right plan for you.
