The Parts of Medicare 

WHAT ARE THE PARTS OF MEDICARE

Medicare has 4 parts: A, B, C, and D. Each part covers different costs that effect different areas of health care that are available to participants. Parts A and B fall under the guidance of the Centers for Medicare and Medicaid Services or CMS. Private insurance carriers administer Parts C and D. All the parts work exactly like the health care coverage you are used to. Visits to the doctor, hospital care, prescriptions, and laboratory testing. Vision and dental are also covered if your plan has that provision. 

Tell Me About Part A
Part A or hospital insurance covers inpatient hospital services and skilled nursing care. This is available, premium free, to Americans who have turned 65 and they or a spouse paid into Social Security. Participants receiving Part B, disabled, or diagnosed with end stage renal disease receive it automatically.


Part A Coverage:

Hospital inpatient care

Care for a skilled nursing facility

Care while inpatient in a skilled nursing facility

Care while in Hospice

Care administered by a home health care agency


Part A Cost

There is no premium for Part A if you or your spouse have worked 40 calendar quarters at a job where you paid Social Security taxes. If you do have to pay a premium, the 2021 cost for that premium is $471.00 if you worked less 30 quarters. If you worked quarters 30-39, your premium for 2021 will be $259.00.

Deductible (the amount of your medical care cost that must be reached before your medical coverage picks up payment) for Part A for 2021: $1,484.


Part A Enrollment Period

Upon applying for Social Security, you receive automatic Part A enrollment. If you do need to enroll, you can do so anytime during your Initial Enrollment Period that covers the three months prior to your birth month, your actual birth month and up to three months following your birth month.

 

Tell Me about Part B

Part B is the medical plan coverage taking care of medically necessary outpatient and physician care services which includes:

Necessary services/supplies/equipment including durable medical, i.e.: wheelchairs, crutches, hospital beds, etc.

Preventive care

Medical research

Ambulance

Behavioral health services

Surgical second opinion

Certain medications as an outpatient


What is the cost for Part B?

Part B costs for 2021:

Premium: $148.50/month–this amount depends on your income

Deductible: $203.00

Coinsurance: 20%


Part B Enrollment Period

When you apply for Social Security, you receive automatic Part B enrollment. If you do need to enroll, you can do so anytime during your Initial Enrollment Period that covers the three months prior to you turning 65, your actual birth month and up to three months following your birth month.

 

Tell Me About Part C

Advantage Plans (or Part C) provides all the coverage/benefits of Parts A and B, but also may offer prescription benefits, plus vision and dental care. These plans are being offered to participants with ESRD or end-stage renal disease as of 2021. Part C enrollment is projected at 26 million participants for 2021. The out-of-pocket maximum for Part C has increased to $7550.00 for 2021.

Part C includes:

Hospital coverage

Medical/physician coverage

Prescriptions or Part D

Vision (corrective lenses, exam)

Dental (cleaning, exams)

Hearing (hearing aid, exam)

Preventive/wellness strategies


Part C Premium

Part C premiums averaged $33.00 in 2020 and will increase for 2021. However, many beneficiaries will pay no premium at all other than what they already pay for Part B. Keep in mind that plan costs will vary widely according to MedicareUsa.


Part C Enrollment Period

Part C enrollment is optional and not automatic as with Parts A and B. If you are enrolling, you can do so anytime during your Initial Enrollment Period that covers the three months prior to when you turn 65, your actual birth month and up to three months following your birth month. To be eligible for Part C, you must be enrolled in Parts A and B. Your Part C premium is paid to your private insurance carrier.

 

Tell Me About Part D

Prescription drugs coverage is offered through Part D. The drug formulary (a generic and brand name drug list) offered by your insurance carrier will list the prescriptions that are available through your plan.


Part D Cost

The 2021 Part D premium $30.50 per month. Keep in mind that deductibles can range from $0 to $445.00. This varies due to the plan you have chosen.


Part D Enrollment Period.

Part D enrollment covers the three months prior to your 65th birthday, your actual birth month and up to three months following your birth month. However, you will need to enroll for Part D through your insurance carrier. 

Wrapping It All Up

Since 2020 was the year of Covid-19, costs for each of these plans have risen to cover the added care costs for this disease. In October 2020, Congress enacted a spending bill that limited the amount to 25% of what the increase would normally be.

The coverage you need is equal to what services you need to cover. Here are a few questions to ask yourself when deciding what plan you need.

What expenses can I afford to pay myself?
Do I need to change my current doctors?
Can I still get my current medications?
Are my doctors and/or care facilities conveniently located?

Finally, it is always a good idea to assess the healthcare needs of yourself and/or your spouse each year. This gives you a rough guide to where you need to be financially so that you can be prepared should things change.