Medicare

Medicare Part A includes your hospital expenses. This covers hospital stays, skilled nursing care, hospice, and home health-care services. You may have to pay various deductibles, coinsurance, and copayments. Part A is earned by paying taxes toward Medicare while working for 10 years (or 40 quarters). A premium will be paid if you did not earn Part A.

Medicare Part B includes services that treat illnesses or conditions. This covers doctor’s office visits, lab work, x-rays, and outpatient surgeries. It also covers preventive services such as cancer screenings and flu shots. In addition, Part B covers medically necessary durable medical equipment such as wheelchairs and/or walkers to treat a disease or condition. Most people pay a premium for Part B. You will still need to pay your Part B premium even if you are enrolled in a Medicare Advantage plan that provides your Part A and Part B benefits.

Prescription Drug Plans

Prescription drugs are not covered by Original Medicare. Despite being optional, Medicare Part D coverage can be helpful if you use prescription medications. If you don’t sign up for Medicare Part D Coverage when you first become eligible, you will be charged a late-enrollment fee. Either a Medicare Advantage Plan that offers prescription drug coverage, or an independent Prescription Drug Plan (PDP), are the two ways to obtain Medicare Part D coverage for prescription medications.

Original Medicare is utilized in conjunction with a Medicare Supplement Insurance Plan. Any caregiver that accepts Medicare will accept a Supplement because they only have to bill Medicare. Medicare pays its share (typically 80% of the benefits covered by Medicare) and transfers the remaining balance to the Supplement, which pays its share (typically 20%). It is vital to understand that Supplements do not include Prescription Drug Coverage (Part D, PDP), and there will be a penalty for people who do not initially enroll in a PDP. However, there are several exceptions. The coverage of a Medicare Supplement does not alter from year to year, even though the cost typically increases.

Medicare Advantage Plans, often known as "Part C" or "MA Plans," are a "all-in-one" alternative to Original Medicare. They are provided by privately owned businesses that have Medicare approval. You can still use Medicare if you sign up for a Medicare Advantage Plan. Medicare Parts A, B, and frequently Part D, which covers prescription drugs, are all included in these "bundled" plans.

Medicare Prescription Drug Plan, also referred to as Part D. These policies—often referred to as "PDPs"—include prescription drug coverage in addition to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans. Each Medicare Prescription Drug Plan has an individual list of drugs that are covered (referred to as a formulary). On their formularies, several Medicare drug plans group medications into various "tiers." Each tier has a different price. You will typically pay less for a medicine in a lower tier than one in a higher tier. In certain instances, you or your doctor can ask your plan for an exception to earn a lower copayment if your drug is on a higher tier and your prescriber believes you require that drug instead of a similar drug on a lower tier.