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MEDICARE ABC & D's

Medicare Coverage Choices

What is Medicare and how is it structured?

Medicare is health insurance for individuals age 65+ as well as recipients of Social Security Disability Income for at least 2 years and people who have End Stage Renal Disease.  Medicare is administered by the federal government in conjunction with private insurance carriers.  Medicare is divided into four parts: A, B, C and D.

When one begins Medicare, there are two distinct ways to creating your health insurance future: 

Either enroll in a Medicare Advantage Plan OR keep Original Medicare.


A patient in a hospital room interacts with a nurse

Medicare Part A: In-Hospital Care

  • Part A covers inpatient hospital stays, skilled nursing facility (SNF) stays, limited home health visits, and hospice care due to diagnosis of a terminal illness. 
  • Part A benefits are subject to a deductible ($1,556 per benefit period in 2022). 
  • Part A also requires coinsurance for extended inpatient hospital and SNF stays. 
  • To qualify for SNF stay, one must arrive after an inpatient stay for a minimum of three days. Neither observational status nor the day of discharge count toward the three day requirement.

A doctor gives advice to a patient

Medicare Part B: Outpatient Care

  • Part B covers medical care, some examples include: 
  • Physician office visits 
  • Diagnostic testing - MRI, CT Scans, etc.
  • Preventive services -mammography, annual wellness visit, cancer screenings
  • Outpatient hospital care and surgery 
  • Durable medical equipment (wheelchair, oxygen, diabetic supplies) 
  • Ambulance in life threatening emergency 
  • Physical, occupational, and speech therapy   
  • Medication and injections given in the doctor's office/hospital setting
  • Most Part B benefits are subject to a deductible ($233 in 2022) and 20% coinsurance. 

A group of healthcare professionals

Medicare Part C: Medicare Advantage Plans

  • Part C is also known as Medicare Advantage (MA) and is a different way to get your Medicare benefits. 
  • MA plans are network-based health insurance plans provided by private companies that contract with Medicare. 
  • Beneficiaries enroll in a private health plan, such as a health maintenance organization (HMO) or preferred provider organization (PPO). 
  • MA plans include all Medicare-covered Part A and Part B benefits and typically also include Part D, prescription drug benefits.
  • Some MA plans may offer coverage for vision, dental, hearing, health and wellness programs. 
  • Referrals and prior-authorization may be necessary, depending on the plan. 
  • Co-pays and cost sharing is a part of the structure of MA plans, with annual maximum financial out-of-pocket limits. 
  • There are MA plans specifically created for beneficiaries who are dual-eligible for both Medicare and Medicaid. 
  • And while the MA plan IS your health insurance, you must be enrolled in Part A and Part B.

Prescription drugs

Medicare Part D: Prescription Drug Coverage

  •  Part D covers outpatient prescription drugs through private plans that contract with Medicare. 
  • Plans can be stand-alone prescription drug plans (PDPs) or included within a Medicare Advantage plan (MA-PD). 
  • The Part D benefit helps pay for enrollees’ drug costs and provides coverage to fill those medications. 
  • All Part D plans have the same four-tier structure and can have different formulary, list of medications, it will cover. 
  • Enrollees pay monthly premiums and cost sharing for prescriptions, with costs varying by plan. 
  • Reviewing your Part D plan should be done on an annual or semi-annual basis, as plan premiums and formularies can change. This Annual Enrollment Period occurs each year between October 15 - December 7.
  •  Additional financial assistance is available for beneficiaries with low incomes.  Contact Social Security to see if you qualify for subsidies.

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