Whether you’re on Medicare, are looking to enroll or are a caregiver to a Medicare patient, the list of different plans and options can be confusing to navigate.
Medicare is a federal insurance program for adults who qualify due to age, disability or certain health conditions, but that’s just the beginning.
What coverage do you need? What are the costs? Do you have any options or is Medicare a one-size-fits-all program?
Don’t stress out. Learning the basics of Medicare can be as easy as A, B, C and D.
What is Medicare Part A?
Medicare Part A pays for inpatient treatment at hospitals and skilled nursing facilities, as well as hospice care and home care.
Most people on Part A don’t pay a premium, but there are some out-of-pocket expenses, including a deductible and coinsurance.
Medicare Part A, together with Part B, is sometimes called Original Medicare. Part B pays for doctor visits, tests and some medical supplies.
What does Medicare Part A cover?
Medicare Part A covers inpatient medical care, including:
- Hospital inpatient care
- Mental health inpatient care
- Skilled nursing facility care
- Hospice care
- Home care
Under Part A, you can choose any doctor, health care provider, hospital or facility that is enrolled in Medicare and is taking new patients. Generally, you don’t need a referral to see a specialist.
Medicare Part A doesn’t cover regular doctor visits, screenings or preventative care. Those services are covered by Part B.
Nor does Part A cover most prescription drugs, except for those to relieve pain or control symptoms in hospice patients. Prescription drugs are covered by Medicare Part C (Medicare Advantage) or Part D (prescription drug) plans.
Also, Part A doesn’t cover long-term care, cosmetic surgery or most dental, hearing and vision care.
What is Medicare Part B?
Medicare Part B is medical insurance that pays for doctor visits, screenings and other outpatient services and supplies. You’ll pay a monthly premium and have a deductible and coinsurance payments.
The standard Part B premium is $170.10 a month in 2022, but you could pay more, depending on your income and if you didn’t sign up when you first became eligible.
The annual Part B deductible is $233. After meeting the deductible, you’ll pay 20 percent of the Medicare-approved amount for most doctor services, outpatient therapy and durable medical equipment. You’ll pay nothing for other services, such as preventative care.
What does Medicare Part B cover?
Part B covers two types of services:
- Medically necessary services: Services and supplies that meet accepted medical standards and are required to diagnose or treat a medical condition. These include ambulance services, durable medical equipment, mental health services, outpatient hospital services and a limited number of prescription drugs.
- Preventative services: Vaccinations, wellness visits and screenings related to mental health, cancer and other health conditions. Most preventative care is free if the provider accepts assignment.
If you have Part B, you can use any Medicare doctor, health care provider, hospital or facility that is taking new patients, and you can see a specialist without a referral.
What is Medicare Part C?
If you’ve heard of Medicare Advantage, you’ve heard of Medicare Part C.
Part C consists of Medicare-approved plans sold by private insurance companies. These Medicare Advantage plans typically package the hospital and health insurance benefits of Parts A and B (Original Medicare) with prescription drug coverage.
There are important tradeoffs to consider when deciding between Original Medicare and a Part C plan.
A Medicare Advantage plan often requires you to use doctors in the plan’s network, and you’ll probably need a referral to see a specialist.
But Medicare Part C plans usually pay for services not covered by Original Medicare, such as vision, dental and hearing care, and may have lower out-of-pocket costs.
Medicare Advantage plans come with different premiums, deductibles, copayments and coinsurance, so shop around to see how they compare to each other and to Original Medicare.
What is Medicare Part D?
Medicare Part A and Part B don’t cover most prescription drugs, so if you choose Original Medicare, you might want to get a Part D plan to help you pay for medication.
Like Part C, Part D includes Medicare-approved plans from private insurance companies.
Part D plans vary by what they charge in premiums, deductibles, copayments and coinsurance, and by their formularies, the lists of brand-name and generic drugs they cover.
Remember, most Medicare Advantage plans already cover prescription drugs and won’t allow you to join a Part D plan.
Where can I find a primary care physician who accepts Medicare patients?
NewPrimaryCare.com can help you find a Medicare primary care doctor near you. All of our provider partners practice value-based care, meaning Medicare rewards them for helping patients get healthier, rather than for the number of patients they treat. With our quality providers, you can expect quicker appointment scheduling, shorter waits at the doctor’s office and a meaningful connection with your physician.
Use our Find Your Doctor tool to search for and compare value-based care providers near you.