Decoding Medicare

 
 
A caricature of David juggling blocks with the letters A, B, C, and D.

Most Americans automatically become eligible for Medicare upon turning 65 years old, but they don’t realize that enrolling in Medicare—without incurring penalties—requires making important choices well before they become eligible.

When considering Medicare Parts A, B, (C), and D, you should know that each plan requires separate enrollments and a series of choices, which you should make in consultation with a Certified Medicare Advisor.

As your Certified Medicare Advisor, I can help you decipher the “alphabet soup” of (Original) Medicare and Medicare Advantage plans (and options for supplemental coverage) to find the plan that provides both the security and coverage that you’re looking for, works with your budget, and also gives you peace of mind.

A sample Medicare card reads Part A: Hospitalization Insurance.

What it covers

Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.

What it costs

Most people who are enrolled in Part A do not pay monthly premiums*. Those costs were covered by the payroll taxes that they or a spouse paid while they were working.

*There are a few exceptions, which I will cover in a phone call.

A sample Medicare card reads Part B: Medical Insurance.

What it covers

Helps cover services from doctors and other health care providers (including lab tests), outpatient care, home health care, durable medical equipment (like wheelchairs, walkers, etc.), and many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits).

What it costs

You won’t be automatically enrolled in Part B*. Those who enroll in Part B can expect to pay a premium and a deductible.

*Because Part B is optional, the time at which you choose to enroll in it—if you do—can significantly affect your costs.

A sample Medicare card reads Part C: Medicare Advantage.

What it covers

Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.

In most cases, you’ll need to use doctors who are in the plan’s network.

Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.

What it costs

Plans may have lower out-of-pocket costs than Original Medicare.

A sample Medicare card reads Part D: Prescription Drug Coverage.

What it covers

Part D includes Medicare-approved plans provided by private insurers to help you pay for prescription drugs.

What it costs

In most cases, you’ll pay a monthly premium and copays. Some plans also include deductibles for prescription drugs.

*Drug prices will differ from plan to plan according to each company’s drug price sheet or “formulary.”

DISCLAIMER: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE  or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options.