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If you want to reevaluate your Medicare coverage, now’s your chance. The period between October 15-December 7 is Medicare’s Annual Enrollment Period (“AEP”), and it’s the perfect time to sign up for or switch to a plan that works best for you.
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Medicare can be complicated, so we’re breaking it down to the ABC’s and D. For starters, Medicare parts A, B, C and D all cover different aspects of care, and have different associated costs.
Often referred to as “Original Medicare,” Medicare Parts A and B work together to provide both hospital and medical coverage, while Medicare Part C is Medicare Advantage and Part D provides prescription drug coverage. Each of these parts provides different benefits that are important for you to consider.
Medicare Part A
Medicare Part A covers charges from hospitals, including inpatient hospital care, care in a skilled nursing facility, nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care), hospice care, and some home healthcare. Part A coverage allows you to go to any hospital or facility that accepts Medicare; there are no network restrictions.
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While the majority of people do not pay a premium for Medicare Part A, there is a deductible, as well as other shared costs, such as “copays” and “coinsurance” for various services. These are costs you’ll have to pay out of pocket.
Medicare Part B
As for Medicare Part B, it covers costs for medically necessary and preventive services from doctors who accept Medicare. That includes clinical research, ambulance services, durable medical equipment, mental health, and limited outpatient prescription drugs. Similar to Part A, those with Part B coverage have no network restrictions and can see any doctor that accepts Medicare.
Unlike Part A, which is generally premium-free, Medicare Part B does have a monthly premium, which started at $144.60 in 2020. While the Part B deductible currently starts at $144.60, the unlimited coinsurance is 20 percent of the Medicare approved and covered services and equipment.
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Working together, Medicare Parts A and B provide hospital and medical coverage. Due to the out-of-pocket costs associated with these plans, including deductibles and coinsurance, some people choose to reduce their out of pocket cost exposure with a Medicare supplement plan. Medicare Part D is also available for those who need prescription drug coverage.
Medicare Part C
Medicare Part C, or Medicare Advantage, provides Medicare Part A and Part B coverage through Medicare-approved private health insurance companies who follow Medicare’s rules. To enroll in a Medicare Advantage plan, you must be enrolled in Medicare Parts A and B and live in the plan’s service area.
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Although it may seem similar to Original Medicare, please note that Medicare Advantage is a different plan than Original Medicare. Unlike Original Medicare, a Medicare Advantage plan will generally have a network of doctors that you must choose from for your services to be covered under the plan. Out-of-network services are not typically covered, although it does vary by plan.
To help contain your health care costs, Medicare Advantage plans set an annual out-of-pocket limit. That means you know the maximum amount you’ll be expected to pay for your health care each year, as long as you use the health plan’s network.
Many Medicare Advantage plans have $0 premiums, meaning most people only have to pay a premium for their Medicare Part B coverage, which is required for any Medicare Advantage plan.
The additional benefits of a Medicare Advantage plan vary by carrier. However, most plans offer prescription drugs, vision, dental and even hearing benefits. In addition, some Medicare Advantage plans cover benefits such as massage, acupuncture, gym memberships, and wearable devices. Check out the plans available in your area here.
Medicare Part D
Medicare prescription drug coverage is provided under Part D. Medicare Part D can be provided in a stand-alone plan with Original Medicare, or through a Medicare Advantage plan that offers drug coverage.
If you sign for a stand-alone plan, you will pay a monthly premium, which will vary depending on the plan and coverage you choose. Most plans also have additional deductibles and copayments.
Similar to Part B, if you don’t sign up for Part D when you are first eligible, you will likely be subject to a penalty for the months you could have had coverage but you didn’t. The AEP is the perfect time to evaluate if you should consider Part D prescription drug coverage if you don’t already have it.
During Medicare’s Annual Enrollment Period, remember the ABC’s (and D!) of Medicare: Part A is hospital, Part B is medical, Part C is Medicare Advantage, Part D is prescription drug coverage.
Jan Dubauskas is a health care expert, enthusiastic insurance pro, attorney and mom serving as Vice President of healthinsurance.com. Twitter @DubauskasJan
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