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Older Adults

Understanding Your Medicare Benefits

Understanding your health care benefits has never been an easy task. Once you enter the world of Medicare, it doesn't get any easier.

Medicare is the federally funded health coverage plan available to adults ages 65 and older. You can enroll during the three months before turning 65 and for seven months after, or during the annual enrollment period.

Medicare has different parts, called Medicare Part A, Part B, Part C, and Part D. Each offers different types of coverage.

Below is an overview of the different Medicare parts and what they offer.

Medicare Part A

Part A is included in your Original Medicare coverage. It covers care in a hospital or inpatient facility, nursing home care, hospice, and home health services. Generally, you can choose the healthcare providers and hospitals you prefer. Part A doesn’t cover your deductible, which is the money that you must pay before your coverage will start to apply. Part A also doesn’t cover your coinsurance, which is the percentage of costs you must pay after your deductible has been met. You will either pay for your deductible and coinsurance yourself. Or you can get an additional Medicare plan to cover those costs not included in Part A. This additional plan is called a supplemental plan.

Medicare Part B

Part B also is included in your Original Medicare coverage. It covers your medical care, including doctor appointments and preventive care, as well as any medically necessary supplies such as a wheelchair. Although costs vary, usually you pay a monthly premium, or fee, for your Part B coverage. Your deductible still applies for doctor visits.

Medicare Part C

Part C combines both Part A and Part B, so it covers both hospital care and care at the doctor's office. But Part C is also called a Medicare Advantage Plan. It is not part of Original Medicare, and you have to pay an extra monthly premium for it. Medicare Advantage programs are offered through private insurance companies. In most cases, you will have to use the hospitals and healthcare providers within the insurer's network. Each Medicare Advantage plan has different costs and rules.

Medicare Part D

This part covers your prescription drugs. You must have Part A and Part B or Part C  to enroll in a prescription drug program. All Part D plans are offered through private insurance companies. They have varying rates and coverage for different drugs. If you have a Medicare Advantage plan, you will probably need to choose a Part D plan from the same insurance company.

Supplemental insurance

Supplemental insurance, also called a Medigap plan, is available only to people without Medicare Part C/Medicare Advantage plans. This is designed to cover any gaps in your coverage for costs that are not paid for by Original Medicare. It’s sold through private insurance companies. It has varying costs and rules, depending on the plan and the insurer.

Many different plans are available, with many factors to consider. Before you choose a plan, make sure it will meet your needs. It should cover your specific prescriptions, as well as care from your preferred doctors and hospital.

People on limited incomes may qualify for additional assistance and lower premiums for Medicare benefits. To find out more about Medicare plans, enrollment periods, and cost-saving options, visit the Medicare website.

Date Last Reviewed: 12/1/2016
© 2000-2017 The StayWell Company, LLC. 800 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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