Medicare is a government-sponsored healthcare insurance plan for many people above 65 years old or younger people with specific disabilities, Lou Gehrig’s Disease (ALS) or end-stage renal disease.
Many people who do not know about Medicare think of it as an ‘all under one umbrella’ insurance. However, there are different parts, each covering different health issues, medication needs, and equipment.
Every year, the Centers for medical and Medicaid Services (CMS) release new terms for every Medicare part, including what they cover, the premiums, and deductibles. If you want to enroll for Medicare this year, you need to know the changes in what each part of Medicare covers to determine which one is the best for you or your loved one.
This is hospital insurance for people over the age of 65. It covers inpatient hospital care, some hospice care, limited home healthcare, and short-term skilled nursing facility stays. Inpatient services include nursing services, medications, physical therapy, and meals that doctors deem essential for recovery.
However, it’s important to note that this part does not cover all the hospital costs. Some exclusions include private rooms, long-term care, and blood transfusion if you have to get special blood instead of what is in the hospital’s blood bank.
If you or your partner have been working and paying Medicare taxes for over ten years, you qualify to get Medicare part A for free. However, you must pay a deductible of $1,556 for every benefit period.
If you have not worked and paid Medicare taxes for ten years and above, you must pay a monthly premium depending on the amount of previous coverages and health status.
If you have worked for less than 30 quarters or have specific disabilities and have exhausted other entitlement, you will pay a premium of $499, which has increased by $28 from 2021. If you or your partner have worked and paid Medicaid taxes for between 30 and 39 quarters, your monthly premium will be $74, a $12 raise from 2021.
If you have an Original Medicare part A, you will have a $0 coinsurance for the first 60 days in a skilled nursing facility or hospital. However, from the 61st to the 90th day, you have to pay a $389 coinsurance and a $778 daily coinsurance after the 91st day.
You should consider enrolling for Part A Medicare insurance if you are scheduled to have major surgery or if you have been previously hospitalized. Since most part A covers are premium-free, you should enroll once you are eligible and not automatically enrolled.
If you don’t enroll for the insurance once you become eligible or get automatically enrolled, you will face late enrollment penalties.
Part B insurance covers necessary doctor’s services for health improvement, preventive services, outpatient care, medical supplies, and some health and medical services not covered under Part A insurance. The services usually covered under this part include:
- Bone mass or density measurement.
- Ambulance services.
- Cardiovascular screenings.
- Cardiac rehabilitation.
- Durable medical equipment like foot braces.
- Clinical laboratory services.
- Diabetes self-management training, screening, and supplies.
- Doctor services.
- Cancer screenings.
- Flu, COVID, flu, and pneumococcal shots.
- EKG screening.
- Kidney dialysis services plus supplies.
- Home health services.
- Physical, speech, and occupational therapy.
- Pulmonary rehabilitation.
- Pap tests plus pelvic exams.
- Outpatient mental health care.
- Orthotic and prosthetic items.
If you enroll for Medicare Part B insurance, you will pay a $170.10 monthly premium, a $21.60 increase from 2021. However, you can pay up to $578.30 monthly premiums, depending on your income.
The 2022 deductible for part B is $233, and once you meet it, you will only have to pay 20% of the majority of the Medicare-approved services out-of-pocket.
Part B is a good choice if you are eligible for Medicare but don’t currently have medical insurance. Most people apply for Medicare Part B insurance once they are eligible, but you can delay enrollment if you have medical insurance from your employer or spouse. This, however, will attract late enrollment penalties, so you have to weigh your options.
Also known as the Medicare Advantage plan, this insurance plan gives Medicare benefits through private insurers and follows Medicare-set rules and regulations. When using this plan, you have to work with ‘in-network’ doctors or receive a referral from your primary care doctor. Part C covers:
- All Part A and B services, including selected hospice services, but exclude clinical trials.
- Other benefits like vision, dental, hearing, and wellness program services.
- Transportation between medical appointments.
- Part D services.
Medicare Part C costs differ depending on your insurance provider and their offerings. Some Part c plans come with a $0 premium, but all plans have an average of $19 monthly premium.
Deductibles, coinsurance, and copays also differ depending on the insurance provider. If your Medicare Advantage plan includes Part D coverage, you will also experience the donut hole effects. You can see all available Part C plans on medicare.gov, then compare them to choose the best one.
Part C is a good option if you want benefits not covered in your Original Medicare, like dental and transportation services.
This is an optional cover, and like Part C, you get it from a private insurer, and there are several types to choose from. It usually covers prescription drugs and some vaccines not covered by part B, like the shingles shot. The costs for Medicare Part D usually differ depending on the type and insurer you choose.
However, the CMS state that the average monthly premium for the most part D covers will be $33.37 in 2022. You can apply for the Medicare Help subsidy, which helps you cover part of your Part D cover costs.
Part D insurance is a good option if you use certain prescription drugs often, like diabetes medication. This helps you reduce the cost of buying the drugs. If you do not enroll for Medicare Part B when you qualify and don’t have creditable drug coverage, you will face late enrollment penalties.
Medical insurance is crucial because it helps you save a lot on your medical bills. Most private insurance covers are expensive, so many people opt to enroll in Medicare covers.
However, you must research all the parts and understand their costs and what they cover to determine which one works best for you.