Parts of Medicare: Part A, B, C, D Explained
Medicare, a federal health insurance program for U.S. citizens ages 65 years and older and those with certain conditions, like End-Stage Renal Disease, has four different parts that offer certain coverages. Part A pays for various hospital services, Part B covers certain doctor services and Part D pays for prescription drugs. Part C, also called Medicare Advantage, is a private health insurance alternative to Original Medicare and often bundles Parts A, B and D coverage.
Below, we'll explore more in-depth the coverages and costs for each part of Medicare.
What Are the Different Parts of Medicare?
The different parts of Medicare are Part A (hospital services), Part B (doctor services) and Part D (prescription drugs). Part C is a standalone health plan that offers Medicare coverage but is sold by private companies.
Medicare Coverage and Costs At-a-Glance
Deductible + Coinsurance
$0-$274 per month
Up to $778 coinsurance payment
$170.10 per month
20% of most covered services and equipment
Privately sold Medicare coverage
Medicare Part A: Hospital Services
Also called hospital insurance, Medicare Part A covers inpatient care in a hospital, hospice care, home health care and more. Below are some common services that Part A can pay for:
Inpatient hospital care
Skilled nursing facility care
Some home health care (e.g., physical therapy, occupational therapy services)
The premium for Medicare Part A in 2022 is free or can cost up to $499 depending on how long you've been paying Medicare taxes. If you've paid Medicare taxes for at least 40 quarters (10 years) then Medicare Part A is completely free. Otherwise, Medicare will cost $499 if you've paid Medicare taxes for less than 30 quarters (7.5 years) or $274 if you've paid for 30 to 39 quarters.
A $1,556 deductible — your out-of-pocket cost when receiving approved healthcare services — will apply for each benefit period and you will also be subject to coinsurance payments:
Days 1-60: $0 coinsurance for each benefit period
Days 61-90: $389 coinsurance per day of each benefit period
Days 91 and beyond: $778 coinsurance per "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime)
A benefit period ends when you have not received inpatient hospital services for 60 days. The coinsurance payments will apply when your hospital stay exceeds 60 days.
For each day that exceeds 90 days, you will consume one lifetime reserve day. You have 60 lifetime reserve days over your lifetime, and Medicare will only cover your hospital costs (excluding coinsurance payments) when you have reserve days. Once you exhaust your lifetime reserve days, you are responsible for all costs previously covered under Medicare Part A.
Medicare Part B: Medical Services
Purchasing Medicare Part B affords you coverage for several types of medical services, including (but not limited to):
Alcohol misuse screenings and counseling: Covers up to four face-to-face counseling sessions each year.
Ambulance services: Includes ground ambulance transportation to a hospital or other healthcare facility.
Bariatric surgery: Pays for gastric bypass surgery, laparoscopic banding surgery or some other type of procedure related to morbid obesity.
Preventative services: Flu shots, glaucoma tests and screenings for HIV and Hepatitis B and C and other types of services that detect early signs of illness are covered.
Acupuncture: Covers up to 12 acupuncture visits for eligible chronic low back pain.
Chemotherapy: Covers chemotherapy appointments in a doctor's office, freestanding clinic or hospital outpatient setting.
Chiropractic services: Covers treatment to your spine by a chiropractor.
Chronic care management: Covers treatment for chronic conditions (e.g., arthritis, diabetes). This can include a comprehensive care plan, medication and other support.
Colorectal cancer screening: Covers tests to identify precancerous growths and other early signs of cancer. Covered screening tests may include colonoscopies, fecal occult blood tests and flexible sigmoidoscopies.
Continuous Positive Airway Pressure (CPAP) devices: You may qualify for a three-month trial of CPAP therapy if you've been diagnosed with obstructive sleep apnea.
The premium for Part B in 2022 will cost $170.10 per month. You will also need to pay a $233 deductible plus a 20% coinsurance payment for most doctor services, outpatient therapy and medical equipment.
Medicare Part B Late Enrollment Penalty: For each 12-month period after you become eligible for Part B and do not enroll, your Part B premium will increase by 10%.
For example, say your initial enrollment period was February 1, 2022 and it would cost $170.10 per month. You decide to forego coverage and wait until February 1, 2024 to sign up. Your fee penalty will be 20% since two 12-month periods have elapsed since you were first eligible in 2022.
Instead of paying $170.10, your monthly premium will increase to $204.12 after applying the 20% penalty. This is a $34.02 premium increase for the life of the plan.
Not Covered Under Medicare Parts A and B
While Medicare Parts A and B cover an extensive list of hospital and doctor services, the coverage is not all-encompassing. Generally, Original Medicare will not cover you for the following healthcare services and medical devices:
Long-term care (also called custodial care)
Non-medical care and non-skilled personal care assistance (e.g., home-delivered meals, adult day health care)
Most dental care
Eye exams related to prescribing glasses
Routine physical exams
Hearing aids and exams for fitting them
Routine foot care
Concierge care (concierge medicine, retainer-based medicine, boutique medicine or direct care)
Medicare Advantage, or Medicare Part C, may cover some of the above services, like vision, hearing and dental (more on this in the next section). This is not always the case and you should confirm with your provider before purchasing your Medicare Advantage plan.
Medicare has an online tool that can help you confirm if a test, item or service is covered. If it is not listed online, ask your doctor.
Medicare Part C: Medicare Advantage
Medicare Advantage (MA), or Part C, is an alternative to Original Medicare that bundles Part A, Part B and sometimes Part D into a single health plan. Instead of being a government-funded health plan, MA plans are sold by private insurance companies.
The advantage of an MA plan is that you may find coverage that would otherwise be excluded in Original Medicare, such as vision, hearing and dental coverage. However, you would only be allowed to use doctors within your plan's network. With Original Medicare, you can use any doctor or hospital that accepts Medicare.
Unlike Original Medicare, there is no standard premium for an MA plan — the cost will vary by the provider. Our sample in Orange County, California showed that the Part C premium can range from $170.10 to $567.10 per month in 2022.
Medicare Part D: Prescription Drugs
Medicare Part D pays for prescription drugs, including generic and brand-name drugs. Part D is completely optional and can be purchased at an additional cost to supplement Original Medicare plans. Medicare Advantage (Part C) plans may have Part D coverage already bundled into the plan, but not always. You should confirm with your MA plan provider if you require prescription drug coverage. You cannot buy Part D and Part C together.
There is no fixed premium for Part D coverage and the cost will vary by the individual. Our sample in Orange County, California showed that the Part D premium can range from $7.50 to $160.20 in 2022.
Medicare Supplement Plans (Medigap)
Medicare Supplement Insurance (Medigap) is a policy sold by private companies that pays for some of the costs not covered in an Original Medicare plan, like copayments, coinsurance and deductibles. Medigap may even cover medical care when you travel outside the U.S. To qualify for Medigap, you must have Medicare Parts A and Parts B.
Medigap policies will not include prescription drug coverage. To get the cost of prescription drugs covered, you will need to purchase a prescription drug plan (Part D), which can result in a separate premium for Medigap and Part D coverage if you purchase both.
Medicare Advantage vs. Medigap
A Medicare Advantage Plan is a full health insurance plan that provides coverage under Medicare Part A (hospital care), Part B (doctor services) and sometimes Part D (prescription drugs). MA plans are sold through private insurers.
Medical Supplement Insurance, Medigap, is supplemental Medicare insurance that plugs some of the "gaps" in Original Medicare coverage. Out-of-pocket costs, like copayments, coinsurance and deductibles would be paid for under a Medigap policy.
Unlike Medicare Advantage, Medigap is a supplemental policy to Original Medicare plans and is not a standalone health insurance policy. However, it is similar to MA plans in that Medigap is also sold through private companies.
Standalone health insurance with Medicare Parts A, B and sometimes D
Supplemental policy to Original Medicare plans
Covers hospital and doctor services and sometimes prescription drugs
Pays for costs not covered under Original Medicare (e.g., copayments, coinsurance, deductibles)
Does not cover healthcare services outside the U.S.
May cover medical services outside the U.S.
Where to Buy
Will Medicare Cover All of My Needs?
Original Medicare may not be enough to cover all your needs if you require certain coverage. If your coverage needs are more robust, then you may want to consider enrolling in an MA plan instead of Original Medicare.
Unless you buy Medicare Advantage (sold through private companies), you will not have vision, hearing and dental coverage. Even with Medigap, not all costs and services will be covered under Original Medicare. Be sure to compare plans to ensure that all your coverage needs are met.
Need Medigap or Medicare Advantage?
If you want to reduce your costs with an Original Medicare plan, then buying a Medigap policy can cover your deductibles, coinsurance payments. Dental, vision and hearing will not be covered by Original Medicare and Medigap. If you want all the additional coverages not offered under Original Medicare, consider buying a Medicare Advantage Plan.
SmartFinancial can help you shop and narrow down your options to those that meet your coverage needs and budget. Enter your zip code, answer a few questions and you can receive your free quotes within minutes. You can also call 855.214.2291.
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