{"id":7948,"date":"2019-11-27T08:00:19","date_gmt":"2019-11-27T14:00:19","guid":{"rendered":"https:\/\/www.osfhealthcare.org\/blog\/?p=7948"},"modified":"2022-10-06T08:53:21","modified_gmt":"2022-10-06T13:53:21","slug":"the-abcs-of-medicare-coverage","status":"publish","type":"post","link":"https:\/\/osf-blog.live.imagescape.com\/blog\/the-abcs-of-medicare-coverage\/","title":{"rendered":"The ABCs of Medicare coverage"},"content":{"rendered":"

Medicare<\/a> is the largest public health insurer in the country, covering more than 55 million Americans. It\u2019s a huge program with lots of moving parts. And the four most important parts follow the alphabet: A, B, C, and D. Here\u2019s what you need to know.<\/p>\n

Medicare Part A<\/h2>\n

What it covers:<\/strong> Inpatient hospitalization, hospice care, inpatient care in a skilled nursing facility (not custodial or long-term care), home health care, and inpatient care in a religious nonmedical health care institution<\/p>\n

The details and cost:<\/strong> You are automatically enrolled in Part A when you turn 65 if you\u2019re receiving benefits from Social Security<\/a> or the Railroad Retirement Board<\/a> (RRB). (However, you\u2019ll get your Medicare card three months before your birthday.) If you\u2019re not getting Social Security or RRB benefits, you have to sign up for Medicare.<\/p>\n

If you or your spouse paid Medicare taxes while working, you\u2019re in luck \u2013 there\u2019s usually no premium for you! Otherwise, you may have to pay up to $506 a month in 203. For everyone with Part A coverage, you may have to pay deductibles, copayments, or coinsurance, which vary depending on the service. There is no cap on your annual out-of-pocket costs.<\/p>\n

Medicare Part B<\/h2>\n

What it covers:<\/strong> Medically necessary doctors\u2019 services, outpatient care, durable medical equipment, mental health services, several preventive services, and home health services<\/p>\n

\"senior<\/p>\n

The details and cost:<\/strong> Like Part A, you are automatically enrolled at age 65 if you\u2019re getting benefits from Social Security<\/a> or the RRB<\/a>. However, you can drop the coverage if you don\u2019t want it. If you don\u2019t sign up for Part B when you\u2019re first eligible but change your mind later, you may have to pay a late enrollment penalty for as long as you have Part B.<\/p>\n

The Part B premium for 2023 is $164.90, although it might be higher depending on your income. There is also a deductible ($226 for 2023), after which you typically pay 20% of the Medicare-approved amount of the service. No cap is provided for annual out-of-pocket expenses. However, most preventive services are free.<\/p>\n

Medicare Part C<\/h2>\n

What it covers:<\/strong> Also called a Medicare Advantage Plan<\/a>, this is offered by Medicare-approved private companies. These plans include all the benefits covered under Parts A and B. In addition, most cover prescription drugs and other benefits not included in Medicare Parts A and B, such as vision, dental, and hearing services.<\/p>\n

The details and cost:<\/strong> You pay the Part B premium and, in some instances, an additional premium for the Medicare Advantage Plan. Unlike Parts A and B, Medicare Advantage out-of-pocket costs are capped each year. Once you reach this limit, you\u2019ll pay nothing for covered services.<\/p>\n

Medicare Part D<\/h2>\n

What it covers:<\/strong> This is the newest part of Medicare, added in 2006. It provides prescription drug<\/a> coverage and, like Part B, is voluntary. (People with Medicare Advantage typically get their drug coverage through their plan.)<\/p>\n

The details and cost:<\/strong> If you\u2019re not in a Medicare Advantage plan, you can sign up for a prescription drug plan and pay a monthly premium, which varies based on the plan. Many also have deductibles and copayments.<\/p>\n

Most Medicare Part D drug plans have a coverage gap, called the \u201cdonut hole.\u201d Once you and Medicare together spend a certain amount on drugs ($4,660 in 2023), you are \u201cin the hole\u201d and pay 25% of the plan\u2019s cost for covered brand-name and generic drugs. Once you spend $7,400 out of pocket, you climb out of the gap, and Medicare covers most of your costs for the rest of the year.<\/p>\n

Find your plan<\/h2>\n

OSF HealthCare participates in most Medicare plans<\/a>, including Part D and Medicare Advantage<\/a> plans.<\/p>\n","protected":false},"excerpt":{"rendered":"

Medicare is the largest public health insurer in the country, covering more than 55 million Americans. Find out what you need to know.<\/p>\n","protected":false},"author":82,"featured_media":7983,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[129],"tags":[887,925],"coauthors":[895],"class_list":["post-7948","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-miscellaneous","tag-aging","tag-billing-insurance"],"yoast_head":"\nThe ABCs of Medicare coverage | OSF HealthCare<\/title>\n<meta name=\"description\" content=\"Medicare is the largest public health insurer in the country, covering more than 55 million Americans. 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