Age Spots: Medicare by the Parts

Jackie Dover

At Aging Matters, we get many Medicare questions. Some are very complex, but many of the frequently asked questions are easier to answer. This article will help to answer some of those easier ones.

What is Medicare? Simply put, Medicare is health insurance managed by the government for those 65 and older and some younger who have been declared disabled.

What does Medicare cost? Is it free? Medicare is not free. When you are working, you and your employer contribute into the Federal Insurance Contributions Act (FICA), and if you or your spouse contributed for 10 years, you are eligible for premium free Part A. If you or a spouse did not pay taxes for the needed 10 years, then there is a premium for Part A, up to $458 monthly. Medicare Part A also has a deductible of $1,408 per benefit period. The standard premium for Medicare Part B in 2020 is $144.60 monthly. The Part B deductible is $198 this year. Those who have higher incomes — above $87,000 for a single person and above $174,000 for a couple — pay higher Part B and Part D premiums. After the Part B deductible, Medicare pays 80% of the approved amount, leaving 20% as the beneficiary’s responsibility.

What does Original Medicare cover? Medicare Part A covers inpatient care in a hospital, which includes expenses that are critical to care such as a semi-private room, nursing services, medications, meals and other supplies and services needed for your care.

Skilled nursing care is therapy and nursing care that can only be safely and effectively performed by or under the supervision of professional technical personnel. You must have a qualifying hospital stay and the services must be medically necessary. Skilled nursing is only for a limited time. Skilled care can include physical therapy, occupational therapy, meals, skilled nursing care, medications, medical supplies and medical social work.

Hospice Care is covered if a doctor certifies that you are terminally ill and have a life expectancy of six months or less and you agree to only palliative care, which are comfort measures not trying to cure your ailment. Hospice care can be in a home or other facility where you live. Hospice care can be stopped at any time if a Medicare beneficiary wants to attempt curative treatments.

Home Health is for those who are certified by their doctor as homebound and need intermittent or part-time skilled nursing care or therapy services.

What does Part B cover? Preventive services such as diabetic screenings, colorectal cancer screenings, mammograms and prostate cancer screenings are covered by Medicare Part B with no out-of-pocket costs for most of the tests and screenings. Medicare Part B also covers outpatient services such as doctor visits, X-rays, lab work and medically necessary durable medical equipment.

What does Part D cover? Part D is the prescription drug coverage for Medicare. It is offered by private companies that have contracts with Medicare. The cost of the plans and the copay amounts vary.

What does Part C cover? Medicare Part C is also known as Medicare Advantage Plans. They are managed care programs offered through private companies that have contracts with Medicare. Part C plans cover all the services Original Medicare covers; they often also have prescription drug coverage. Some Part C plans offer additional benefits that Original Medicare does not cover, including vision, dental and hearing benefits. Sometimes, there are additional premiums for those benefits and some of the additional benefits can only be used if you meet certain conditions. Instead of a deductible and 20%, that Original Medicare would cost each Part C plan sets a co-pay for different services. The Advantage Plans also have an out-of-pocket maximum that varies by plan. This way, your costs are capped if you choose one of these plans. Some of these plans do not have a monthly premium, and some do; it is best to look at all the benefits before selecting a Part C plan. In addition, remember that most have a network of doctors you need to use to get the best cost and coverage. So if you travel, you need to be aware of what may and may not be covered.

What is a Medicare Supplement? Medicare Supplements or Medigap plans cover some of the costs that Original Medicare does not, including the Part A deductible and the 20% co-insurance for Part B. They are designed to work only with Original Medicare and do NOT work with Medicare Advantage/Part C plans. Supplements will have a monthly premium that will vary by company and plan. In most cases, if Medicare does not cover a service, the supplement will not cover it, either. These plans are standardized, and each standardized plan offers the same benefits no matter what company it is through. So every N plan will cover the same things, but the cost can vary depending on what company you get.

Many times, people confuse Medicare Advantage plans and Medicare Supplements, but they are very different. One fills in the gaps in Original Medicare and the other is a different way to get your Medicare coverage. You cannot have both a Medicare Advantage Plan and a Medicare supplement.

This is just a small sample of the Medicare questions we answer. If you have questions about your Medicare coverage, please call Aging Matters at (800) 392-8771.