Navigating Medicare Health Insurance can sometimes be a bit confusing.  What do the letters mean and who is entitled to Medicare health insurance?

The Medicare Parts A, B, C and D stand for different kinds of healthcare insurance coverage.  A person desiring Medicare health insurance coverage has the option of enrolling in the original Medicare track of Medicare Parts A and B; or in the alternative, they can opt for a Part C Medicare Advantage managed care plan. With either track, one will also need to obtain Part D coverage.

PART A – Hospital Insurance
PART B – Medical Insurance
PART C – Advantage Plans (include A and B)
PART D – Prescriptions

Additionally, any deficiency in healthcare insurance coverage under either track may necessitate the purchase of supplemental healthcare insurance coverage.  Below are specifics of each particular Medicare “Part”:

PART A – pays for hospital costs; skill nursing facility rehabilitation care; hospice care; some home health care.

  • Premium for most people is free
  • Hospital in-patient deductible – $1,340
  • Hospital coinsurance Days 1- 60 $0
    Days 61 – 90 $335/day
    Days 91 and beyond $670/lifetime reserve day after 90 (up to 60 days over your lifetime)
    Beyond lifetime reserve days: all costs
  • Skilled nursing facility stay Days 1- 20 $0
    Days 21 – 100 $167.50/day
    Beyond 100 days: all costs

PART B – pays for costs of medically necessary services. You should review specific medical services covered.

  • Premium for most people – $134
  • Deductible – $183 / year and then you pay 20% of costs

PART C – Medicare Advantage Plans.  Plans vary and you should review specific medical services covered and respective costs.

  • HMO – Health Maintenance Organization
  • PPO – Preferred Provider Organization
  • PFFS – Private Fee-for-Service

PART D – pays for costs of prescription drugs.

  • annual deductible, coinsurance until $3,750 then COVERAGE GAP (you pay 35% of plan’s cost for name brand prescriptions and 44% of plan’s cost for generic), once $5,000 then small coinsurance or copayment until end of the year.

Not everyone is entitled to Medicare healthcare insurance. You are eligible for premium-free Medicare Part A if:  i.) you are a citizen or permanent resident of USA, ii.) are age 65 or older and iii.) you or your spouse worked and paid Medicare taxes for at least 10 years.  You can also receive Medicare Part A if you are under 65 and have certain disabilities or have end-stage Renal Disease.  If you are not entitled to premium-free Medicare Part A coverage, it can be purchased.

Medicare Part B is a voluntary program which requires the payment of a monthly premium for all months of coverage.  Enrollment in Medicare Part B can only happen at certain times and requires the payment of a monthly premium for all months of coverage.  If you are eligible for Medicare Parts A and B, then you can opt to purchase Part C Medicare Advantage managed care plan instead of Medicare Parts A and B. Finally, anyone who is entitled to Medicare Part A or enrolled in Medicare Part B can join a Medicare Part D prescription drug plan. This can be a stand-alone plan that complements Medicare Part A and Part B coverage, or it can be part of a Part C Medicare Advantage managed care plan that rolls together hospital, medical, and prescription drug insurance.

If you or a loved one needs assistance navigating the Medicare Plans, the elder law attorneys of HRMM&L would be happy to meet with you, review the particulars of your situation and assist with your Medicare needs to allow you to act with confidence and peace of mind.