WELFARE

Medicare Health Plan: What are the different parts and what benefits do I get?

The Medicare health plan is composed of various parts, and each one includes different benefits. Find out which one is most appropriate for your needs.

STEPHANE MAHEREUTERS

Medicare offers health insurance programs for adults 65 and older, as well as other eligible individuals with specific medical conditions or disabilities.

This insurance has several plans, known as parts A, B, C and D, in addition to Medigap. These components cover different needs and provide different benefits.

Medicare Health Plan: What are the different parts and what benefits do I get?

Part A

This covers hospital and hospice care, as well as some skilled nursing services.

Most people don't pay a monthly premium for Part A because it's included in Social Security benefits. However, the Part A deductible is $1,600 per stay. For those who haven't worked long enough to qualify for premium-free Part A, the monthly premium is $506 per month in 2023.

Part B

Part B includes doctor visits, diagnostic tests, and other out-of-hospital services.

The standard monthly premium for Medicare Part B enrollees is $164.90 in 2023. The annual deductible for all Medicare Part B beneficiaries is $226 in 2023.

Part C and Part D

Part C, or Medicare Advantage, combines Part A, Part B and Part D, which helps pay for prescription drugs.

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Premiums for Medicare Advantage (Part C) vary by state, carrier, plan type, and specific offer. The amount you pay for Part D deductibles, co-payments and/or co-insurance varies by plan.

According to the Medicare website, drug coverage costs vary depending on the prescriptions and what tier the drug is on, what phase of the drug benefit it is in, the pharmacy, and whether a person gets extra assistance paying the costs of their Medicare drug coverage.

Medigap

Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private company that helps you pay your share of the costs in Original Medicare. You can only buy Medigap if you have Original Medicare. That means you must sign up for both Part A and Part B.

Medigap policies help cover the out-of-pocket costs associated with Original Medicare, such as the following:

  • Co-pays
  • Co-insurance
  • Deductibles

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Some Medigap policies also cover services that Original Medicare doesn’t, such as emergency medical care when you travel outside the United States.

On the other hand, Medigap plans generally don’t cover the following:

  • Long-term care (such as in a nursing home)
  • Visual or dental care
  • Hearing aids
  • Glasses
  • Private Duty Nursing Services
  • Also, Medigap plans sold after 2005 do not include prescription drug coverage.

For more information, visit the official Medicare website or call 1-800-MEDICARE (1-800-633-4227).

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