Understanding Medicare and what’s included in the different types of plans can be difficult to navigate. This healthcare program consists of many sections that cover different aspects of your health and wellness. To help break down the differences between Medicare Parts A and B and Medicare Parts C and D coverage, we’ve created an easy-to-digest guide for those who are eligible for Medicare.
In addition to discussing what is Medicare, we will also highlight the difference between Medicare and Medicare Advantage to help you determine which one can provide you the most value.
What Is Medicare?
If you’re wondering what Medicare is, we’ve got you covered with the answer. Medicare is classified as a federal health insurance program that only certain Americans can be covered for, including:
- Individuals that are 65 years old or older
- Individuals with certain disabilities at any age
- Individuals with end-stage renal disease
The default plan consists of three main sections labeled Parts A, B, and D, with Part C being for Medicare Advantage. Understanding Medicare and all it has to offer is possible once you learn how all these different sections contribute to the plan. Furthermore, this will also help you better grapes the differences between Medicare and Medicare Advantage.
Exploring Medicare Part A
When understanding the difference between Medicare Part A and Part B and Medicare Part C and Part D, Part A is a good place to start. Those accepted into the Medicare program are automatically enrolled into Part A. This section includes hospital stays, hospice care, and certain types of skilled nursing care that might be required when being treated for a stroke, broken hip, or other types of rehabilitation that are provided within a nursing home or similar facilities.
The majority of individuals enrolled for Medicare in Miami will not need to pay a premium for Part A. Throughout your time employed, Medicare is taken as a tax on paychecks to fund the program for yourself and other eligible people.
When understanding your Medicare options, in particular Part A, you’ll need to know that there isn’t a premium in most instances. However, a deductible is charged each time you’re admitted to the hospital. Most years, this rate changes and is currently $1,484 for 2021. There are ways to cover the deductible and other costs that aren’t covered by the plan through the purchase of a supplemental or Medigap.
Overall, when understanding Medicare, Part A coverage in particular pays for essentially the majority of hospital services within the initial 60 days of being hospitalized. Although, there are a few exceptions, such as not providing private rooms.
Non-American citizens or permanent residents in the U.S. that have not worked for the necessary amount of time to be eligible for Medicare in Miami still have some options. This includes buying into the plan through a Part A premium.
Exploring Medicare Part B
The next important part to understanding Medicare options is Part B coverage. This section covers the following items which indicate the clear differences between Medicare Parts A and B and Medicare Parts C and D:
- Lab tests
- Doctor visits
- Medical equipment
- Ambulance transportation
- Diagnostic screenings
- Additional outpatient services
Part B includes more costs than Part A. Before you decide whether you want to enroll in this section, there are a few other options that may be better suited. For example, if you’re still employed, health insurance is often covered through company benefits, or if you’re protected by a family member’s insurance plan.
However, those that make the decision not to enroll for Part B and aren’t covered by additional insurance will typically find that the monthly premium is higher for Medicare in Miami. As it currently stands, the monthly premium for this section in 2021 is $148.50. Although, this can be greater if your income exceeds $88,000 per year.
Furthermore, Part B includes an annual deductible that is set at $203 for 2021. Along with this, you’ll be expected to pay 20% of the bills incurred from doctor visits, along with other services supplied. For individuals that collect social security, the monthly premium will be taken away from the amount that you normally receive.
Exploring Medicare Part C
When understanding your Medicare options, it’s crucial to know about Part C as well. So, what is Medicare Part C? This section is also called Medicare Advantage.
Those that enroll in Medicare will need to choose between the federally-run, original Medicare plan or Medicare Advantage, which is the private insurance option. Unlike the government-run plan that splits the coverage into different sections, Part C includes the total coverage from this private healthcare program.
With this being said, you’ll still need to sign up for Parts A and B and you will be expected to pay the premium within this private option. However, on top of this, you would need to register for Part C and pick the Medicare Advantage plan that’s best suited for you, along with the private insurance company that is offering the plan.
For those interested in Part C plans, you’ll be happy to know that the plans offered must cover everything that the original one does by law. Although, they can also include additional features such as dental and vision care.
The majority of the Medicare Advantage plans offer some sort of prescription drug coverage. Careful attention must be given when trying to understand what is included and what is not, as all plans can vary.
When understanding Medicare Part C options, you’ll need to know that they usually come in two types:
- HMOs (Health maintenance organizations)
- PPOs (Preferred provider organizations)
The difference is that with HMOs, you usually select a primary care doctor who will manage your care, which includes providing referrals to specialists when required. PPOs work a little differently, because you have access to networks of doctors that consist of many types of specialities and facilities that typically can be seen and used without the need for a referral. It’s important to take note of both types when understanding the Medicare Advantage options available.
Hopefully, by now you have a clearer understanding of the differences between Medicare Parts A and B and Medicare Part C.
Exploring Medicare Part D
Lastly, Medicare Part D helps cover the costs of some prescription drugs. However, this is not offered by the federal government and requires you to select a Part D plan through a private insurance provider.
Those that register for one of the Part D plans will typically face premiums and out-of-pocket costs. This can be in the form of flat co-pays for medications needed or a percentage of the prescriptions bill. Sometimes there is also the possibility that this will also have an annual deductible.
It’s recommended for individuals to check out the official Medicare website to see if the type of medicines you currently need to be covered are accessible through the plans offered. These lists are updated and modified most years, so you’ll need to look at the list during the period that you want to enroll in.
Medicare Help from Experts
We hope that this guide has helped break down all the major parts of the Medicare healthcare program for you. However, with so many varying conditions and rules that apply, it may be hard to determine which is the most suitable option for you to help keep costs low while providing the most value. Corus Advantage affiliated physicians can help explain your available options to ensure nothing is left to chance when making this important decision.
