Do you need the parts of Medicare explained?
Medicare is divided into 4 parts, and most people new to Medicare find this very confusing. Why do there have to be so many different Medicare parts?? And what’s the difference between the parts of Medicare and Medicare plans?
Fortunately, we can break this down to make it simpler for you to understand. Medicare itself has different parts (not plans), so let’s start with those 4 parts of Medicare explained.
Medicare Part A
Part A of Medicare is your hospital insurance. This helps you cover common hospital expenses for things such as the cost of a semi-private room for stays, hospice, home health care and even skilled nursing facility stays. This part of Medicare also covers blood transfusions requiring more than 3 pints of blood.
Part A is also free for most people as long as they have worked at least 10 years in the U.S. or are married to someone who is at least 62 and has worked those quarters.
We often tell our clients to think of Part A as your room and board in the hospital. This part of Medicare provides you a semi-private room for your hospital stay and with meals and medical services while you are in the hospital.
Sometimes particularly healthy people wonder if they may need only Part A. Perhaps they don’t use many medical services yet and so they wonder if they can get away with Part A alone.
However, there are many things that happen in a hospital that fall under another part of Medicare – Part B, so it’s important that you enroll in both A & B unless you have other coverage coordinating with Medicare.
Medicare Part B
Medicare Part B covers your outpatient medical services
Part B of Medicare is for outpatient services that are deemed medically necessary. Medicare Part B includes coverage for services like doctor office visits, lab testing, diagnostic imaging, preventive care, surgeries, ambulance rides, chemotherapy and radiation, and even extensive dialysis care for people with renal failure. Many of these procedures may occur in a hospital. However, they fall under Part B because physicians provide them, so it’s not always easy to determine what is inpatient vs outpatient care.
Sometimes people will ask us if they really need Part B. The answer is YES if Medicare will be your primary coverage or only coverage. Read our blog here to learn more: “Do I Need Medicare Part B?”
Now those two different parts of Medicare – Parts A and B together – make up what we call Original Medicare. They are only two parts that you will sign up for at the Social Security office or Railroad Retirement Board.
Medicare Part C
Medicare Part C is a term for private Medicare insurance
Part C of Medicare is somewhat confusing. Unlike the other parts of Medicare, which cover specific medical benefits, Medicare Part C is just another name for private Medicare insurance. The Balanced Budget Act of 1997 created Part C, which is now referred to as Medicare Advantage.
Medicare Advantage plans are private health plans that you can choose instead of Medicare. You would get your Part A, Part B, and sometimes also Part D all from one insurance carrier. Advantage plans usually have a network of providers from whom you will seek your care.
Part C plans can often have lower premiums than Medigap plans. However, you’ll pay more copays as you go along so they are not necessarily cheaper over the long term.
Before enrolling in this part of Medicare, read our post on Medicare Advantage vs Medicare Supplement. You’ll be choosing one type of coverage or the other, so you’ll want a good understanding of how each type of coverage works.
Medicare Part D
Medicare Part D Plans provide retail prescription drug coverage
Part D is a federally created program to help you lower the cost of your retail prescription drugs. Unlike Medicare Part A & B, you will not enroll in Part D through the Social Security office. Instead, you will select one of the Part D plans available in your county from private insurance carriers.
By signing up for that plan, you will have enrolled in Part D.
Medicare drug plans are optional. You’ll have a monthly premium that you will pay to the insurance carrier. In return, they give you significantly lower copays on your medicines than you would pay if you had no Part D insurance.
There are rules for when you can enroll and dis-enroll from these drug plans, so be sure to visit the Medicare Part D section of our website for more details about how your drug coverage under Medicare will work.
What Parts of Medicare Do I Need?
If Medicare is your only coverage, you definitely need both parts of Original Medicare – Parts A and B. You must have both of these parts to be eligible to enroll in either a Medicare supplement plan or a Medicare Advantage plan.
Most people need Part D as well. You can add this as standalone coverage alongside your Original Medicare and Medicare supplement, or you can look into Medicare Advantage plans that have a built-in Part D drug plan.
Part D is voluntary because some people with other drug coverage may not need it.
What Parts of Medicare are Mandatory?
You will pay substantial penalties for enrolling late if you didn’t have other creditable coverage, such as through a large employer.
To avoid those penalties, you must enroll in both Medicare Parts A and B during your Initial Enrollment Period (again, unless you have other creditable coverage). So while technically, Medicare is not mandatory
Also, once you enroll in Social Security income benefits, you will automatically be enrolled in Medicare Part A. You cannot collect Social Security without having Part A – the two are linked.
Want Personalized Help with your Medicare Parts?
Call today as I can walk you through these 4 parts of Medicare until you understand them well. Call 657-205-1081 for a free consultation. I am very experienced at explaining Medicare parts and how they work. You’ll soon be an expert at different parts of Medicare and what they cover.