Medicare

The Four Parts of Medicare

• Medicare Part A (Hospital Insurance) covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home healthcare services. Most people qualify for premium-free Part A if they or their spouse have paid Medicare taxes for at least 10 years. If you don’t qualify, you can still purchase Part A by paying a monthly premium.
• Medicare Part B (Medical Insurance) focuses on outpatient care, such as doctor visits, preventive services, medical supplies, and certain tests or treatments. Unlike Part A, Part B requires a monthly premium, which varies depending on your income. Most beneficiaries combine Parts A and B to cover both hospital and medical services.
• Medicare Part C (Medicare Advantage) is offered by private insurance companies approved by Medicare. These plans bundle the benefits of Part A and Part B, and often include additional benefits such as dental, vision, hearing, and prescription drug coverage. While these plans offer extra perks, they may have a more limited network of providers and require copayments or deductibles.
• Medicare Part D (Prescription Drug Coverage) helps cover the cost of prescription medications. Like Part C, it is offered by private insurers. Beneficiaries can either purchase a standalone Part D plan or opt for a Medicare Advantage plan that includes drug coverage. Keep in mind that failing to enroll in Part D when first eligible may result in a late enrollment penalty.

Eligibility

• Age 65 or older: You qualify if you are a U.S. citizen or a permanent legal resident for at least five years.
• Under 65: You may be eligible if you have a qualifying disability and have received Social Security Disability Insurance (SSDI) for at least 24 months.
• Specific medical conditions: Individuals with end-stage renal disease (ESRD) or ALS are eligible regardless of age.

Enrollment

• Automatic Enrollment: If you are already receiving Social Security or Railroad Retirement Board benefits, you will automatically be enrolled in Parts A and B when you turn 65.
• Manual Enrollment: If you are not receiving these benefits, you’ll need to apply during your initial enrollment period, which starts three months before your 65th birthday and ends three months after your birthday month.

Costs Associated 

• Part A: Most beneficiaries do not pay a premium, but there may be a deductible for hospital stays.
• Part B: Monthly premiums start at $164.90 (as of 2024) but may be higher for individuals with higher incomes. Part B also includes an annual deductible and a 20% coinsurance for most services.
• Part C and Part D: Costs vary by plan and provider.

Supplemental Coverage

Common Medicare Myths

• “Medicare covers all healthcare costs.” While Medicare provides broad coverage, out-of-pocket expenses like premiums and copayments still apply.
• “I don’t need Part B if I’m healthy.” Opting out of Part B without other credible coverage may lead to a late enrollment penalty.
• “Medicare automatically includes drug coverage.” Prescription drug coverage requires a separate Part D plan or a Medicare Advantage plan that includes it.