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There are four basic parts of Medicare, A through D, plus Medigap, which is a supplement insurance product.
Take a look at what each Medicare part is for to help decide how much coverage you need.
If you or your spouse worked for at least 10 years while paying your Medicare taxes, then you won’t have a monthly premium for Medicare Part A, which covers:
— Overnight hospital stays
— Follow-up nursing care after a hospital stay
— Hospice care
— Some in-home health care costs
You are responsible for paying your copays and deductibles. Together, with Medicare Part B, it’s often referred to as Original Medicare. You’ll want to make sure that you’re enrolled in Part A as soon as possible to avoid penalties.
If you’re eligible for Medicare Part A, then you’re eligible for Part B, which covers:
— Doctor visits
— Outpatient hospital services
— Ambulance services
— Mental health services
— Certain therapies, like physical and occupational
— X-rays, blood work, and other diagnostic services
— Vaccines, annual checkups, and other preventive services
— Wheelchairs, oxygen equipment, and other medical equipment
There is a monthly premium for Medicare Part B, and you’ll also be responsible for copays, coinsurance, and your annual deductible. If you get Social Security benefits, your Medicare Part B premiums will come out of your Social Security check automatically. If you don’t get a Social Security check, you’ll get a bill every three months.
Medicare Part C is more commonly referred to as Medicare Advantage. When you purchase one of these health insurance plans, they replace your Original Medicare plans and offer additional coverage for things like:
— Prescription drugs
— Routine vision screenings, eyeglasses, and contact lenses
— Routine hearing screenings and hearing aids
— Dental exams and dentures
— Chiropractic care
— Podiatrist appointments
— Fitness programs at participating health clubs
— Credits for things like vitamins and cold medicine
Just remember, not every Medicare Advantage plan covers all of the things listed above, so do your research.
There are two types of Medicare Advantage plans:
— Health maintenance organization (HMO)
Covers certain medical expenses as long as they are received by a doctor or facility that’s within your plan’s participating network. HMOs usually offer larger cost savings.
— Preferred provider organization (PPO)
Usually offers a wider network, but also allows you to pay more out-of-pocket and visit a doctor or hospital that’s out of network. These offer more choice, but often higher premiums or other costs.
Not every Medicare Advantage plan covers prescriptions. If yours doesn’t, or if you don’t have a Medicare Advantage plan, then you will want to add Medicare Part D to help you pay for brand name and general prescription drugs. Before you do, you’ll want to look up your medications to make sure they’re covered. Or, make an appointment to talk with a Licensed Medicare Advisor and go over all your options.
Medigap, also known as Medicare Supplement, helps reduce your out-of-pocket costs. While there are no extra benefits that come free with Medigap, you can see any provider that accepts Original Medicare. Plus, Highmark offers great supplement benefit buy up options through Whole Health Balance. You need to have Medicare Parts A and B before you can purchase a Medigap plan, and you’ll also be responsible for a monthly premium in addition to any premiums you may have from your Medicare Part B coverage.
Original Medicare doesn’t cover everything – but you have two other options to choose from to help make sure you’re covered after you retire. We’ll walk you through what Medigap and Medicare Advantage plans cover, their costs, and more.