Medicare Simplified: Part A, B, C, D

Medicare Simplified

Core Medicare is named after our Core Values. Core Medicare’s mission is to provide accurate, unbaised and useful information, enabling our clients to make wise decisions about their personal health care needs. Core is devoted to simplifying and solving all aspects of Medicare, including Medicare Advantage Plan, Medicare Advantage Prescription Drug Plans, Medigap -often referred to as “Medicare Supplements”, Prescription Drug Plans and Dental Plans.

We are currently producing multiple video tutorials to help Americans better understand every aspect of Medicare. Just like our licensed agents provide for our clients, our tutorials will provide essential and valuable information to equip everyone to maximize their benefits and minimize the costs of their personal health care needs.

For now, here is some basic information to better understand Medicare and to help you navigate through the Medicare maze.

Medicare: A (Very Short) History

Medicare originally started-out as our government-run, fee-for-service medical insurance programs for Americans after they turn 65 years old. Back in 1965, President Lyndon B. Johnson signed into law the bill that began Medicare and Medicaid. Medicare has been upgraded throughout the years. For example, in 1972 Medicare was expanded to provide coverage for disabled Americans, people with end-stage renal disease (kidney failure), and people diagnosed with Amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s disease. One of the most significant changes to Medicare occurred in 2003, when President George W. Bush signed the Medicare Prescription Drug, Improvement, and Modernization Act (abbreviated as the Medicare Modernization Act or MMA).

Core Medicare believes Medicare is a good thing, it has worked very well for over 55 years. The improvements over that time have opened the privatization of Medicare in the form of Medicare Advantage plans, also known as “Part C” plans. Technically, Medicare Advantage Plans have been around since 1985, but they weren’t named “Medicare Advantage” plans until 2003 as part of the Medicare Modernization Act (MMA).

We don’t want to put you asleep with a history lesson, but knowing this helps better understand the basics Medicare, and to further know the advantages & disadvantages of the many Medicare options available to you.

As a whole, the Medicare program is administered and regulated by a federal agency within the United States Department of Health and Human Services known as the “Centers for Medicare & Medicaid Services.”

What Is Medicare Today?

Medicare is the federal health insurance program for:

People who are 65 or older
Certain younger people with disabilities
People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

What are the parts of Medicare?

Here are 3 of the 4 different parts of Medicare that help cover specific services:

Medicare Part A (Hospital Insurance)

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B (Medical Insurance)

Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

Medicare Part D (prescription drug coverage)

Helps cover the cost of prescription drugs (including many recommended shots or vaccines).

Part A & Part B Premiums

Most people don’t pay a monthly premium for Part A:

You usually don’t pay a monthly premium for Part A if you or your spouse paid Medicare taxes for a certain amount of time while working. This is sometimes called “premium-free Part A.”

If you don’t qualify for premium-free Part A, you can buy Part A:

If you don’t qualify for premium-free Part A, you can buy Part A. You’ll pay up to $458 each month. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $458. If you paid Medicare taxes for 30–39 quarters, the standard Part A premium is $252.

Everyone pays a monthly premium for Part B:

Most people will pay the standard Part B premium amount. The standard Part B premium amount in 2022 is $158.50. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you’ll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.

Learn more about Part A and Part B Premiums

How Does Medicare Work?

With Medicare, you have options in how you get your coverage. Once you enroll, you’ll need to decide how you’ll get your Medicare coverage. There are 2 main ways:

Original Medicare:

Original Medicare includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). You pay for services as you get them. When you get services, you’ll pay a Deductible at the start of each year, and you usually pay 20% of the cost of the Medicare-approved service, called coinsurance. If you want drug coverage, you can add a separate drug plan (Part D).

Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like copayments, coinsurance, and deductibles. Some Medigap policies also cover services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S.

Medicare Advantage:

Medicare Advantage is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D. Most plans offer extra benefits that Original Medicare doesn’t cover — like vision, hearing, dental, and more. Medicare Advantage Plans have yearly contracts with Medicare and must follow Medicare’s coverage rules. The plan must notify you about any changes before the start of the next enrollment year.

Each Medicare Advantage Plan can charge different out-of-pocket costs. They can also have different rules for how you get services.

Learn about the types of Medicare Advantage Plans

Learn more about how Medicare Advantage Plans Work

Medicare prescription drug coverage (Part D)

Medicare drug coverage helps pay for prescription drugs you need. To get Medicare drug coverage, you must join a Medicare-approved plan that offers drug coverage (this includes Medicare drug plans and Medicare Advantage Plans with drug coverage).

Each plan can vary in cost and specific drugs covered, but must give at least a standard level of coverage set by Medicare. Medicare drug coverage includes generic and brand-name drugs. Plans can vary the list of prescription drugs they cover (called a formulary) and how they place drugs into different “tiers” on their formularies.

Plans have different monthly premiums. You’ll also have other costs throughout the year in a Medicare drug plan. How much you pay for each drug depends on which plan you choose.

Learn more about Medicare drug coverage

Learn more about how to get Medicare drug coverage

Learn more about your costs for Medicare drug coverage

Medicare Advantage plans are offered by managed care organizations (private insurance companies), like UnitedHealthcare, Humana, Cigna, Aetna, Allwell, WellCare, Anthem, BlueCross BlueShield, Alignment and MANY more. It seems like everyone is jumping-into the Medicare arena these days!

These “Carriers” replace the traditional Medicare program, with two primary goals:

Expand Medicare beneficiaries’ choices with more comprehensive benefits than what Original Medicare covers.
Lower the overall cost of Medicare for both the government and the consumer.

Although these two goals were never really met early-on as they were first introduced, the past ten years have proven that Medicare Advantage plans are now exceeding consumer and government expectations.

More and more Medicare beneficiaries are jumping into Medicare Advantage plans as they have been proven, in most cases, to provide more comprehensive coordinated care, extra benefits that Original or Basic Medicare doesn’t cover, and have saved the consumer a lot of money on their health care related expenses.

If you’re considering moving from traditional Medicare to a Medicare Advantage plan, you’re not alone. Medicare Advantage plans are continuing to gain in popularity. So, let’s dig deeper into how exactly these plans work and the advantages and disadvantages of them. As with any major health or financial related decision you make. We always recommend that you talk to an expert about your own personal and unique situation.

Medicare Advantage plans are usually wonderful, but they are not for everyone. Core Medicare’s preferred licensed health-insurance Agents offer both Medicare Advantage plans as well as Medicare Supplement plans. Core Agents provide accurate, unbiased and useful information, enabling our clients to make wise decisions about their personal health care needs. We are the caring experts you can trust to help you make wise decisions.

Doctor & Hospital Choice
Advantages	Disadvantages
Medicare Advantage plans offer a coordinated care approach. The doctors you see generally have a means to communicate with each other. This allows for a health plan to review a patient’s health situation and coordinate services needed to provide individualized care.	If you enroll in an HMO Medicare Advantage plan, you are limited to seeing doctors and hospitals that are contracted with the plan. If all your current doctors are contracted with the plan, that’s great. But doctors can decide not to contract with your plan next year. So, pay attention and check with your doctor each year to make sure they will remain contracted with your plan.
PPO Medicare Advantage plans have a preferred network of doctors and hospitals, but offer the flexibility of using non-network providers, often nationwide.	You may need a referral to see a specialist. Some people view this as a disadvantage while others view that as an advantage…they want their primary doctor and their specialist to communicate with each other.
Bottom line: Medicare Advantage plans limit you to a network of doctors and hospitals. Whereas Original Medicare allows you to see any doctor and any hospital that accepts Medicare.
Costs
Advantages	Disadvantages
Medicare Advantage plans generally have a very low monthly premium, and in large metropolitan areas, the monthly premium can be as small as $0 per month.	Some people just don’t like having co-pays. They would rather pay a flat monthly payment for a Medicare Supplement, and then sleep at night knowing that if they have to use their Medicare coverage, they will not have to pay co-pays or deductibles.
In addition, Medicare Advantage plans put a limit on how much you will pay out of pocket each year. Once you reach your maximum out-of-pocket limit, the plan pays 100% of the Part A and Part B costs.	It’s a good idea to compare your annual cost for a Medicare Supplement to the combined cost of co-pays you would pay in any given year and figure out what will cost more. Of course, this is hard to do because you don’t always know if you will have a medical need each year.
Bottom line: In some cases (remember, your individual needs may be different) your annual costs will be less with a Medicare Advantage plan than Original Medicare with a Supplement.	Some will say, “I’m super healthy…I never go to the doctor.” If that stays true next year, then Medicare Advantage will cost you less. On the other hand, you don’t know what yu don’t know.
Coverage
Advantages	Disadvantages
Medicare Advantage plans must cover at least everything that Original Medicare will cover. So that’s never a worry. It’s the extra perks that are attractive.	Medicare Advantage plans often will require prior authorization before services are rendered. Whereas Original Medicare is a little more straightforward with less hoops to jump through.
In addition, Advantage plans may offer other benefits that Medicare doesn’t cover like these Extras: Dental & Vision Hearing Gym Membership Over-the-counter health catalogs Podiatry Chiropractic, PERS (Personal Emergency Response System), and more!	A Medicare Advantage plan can restrict certain coverage limits. For example, if your doctor recommends that you have eight physical therapy sessions due to a recent outpatient procedure, the plan can come back and restrict your physical therapy visits to five based on “customary and usual”. Your doctor can always push back on the plan, but some don’t like having the headache of this type of thing.
In addition, Medicare Advantage Prescription Drug Plans (“MAPDs”) include the prescription drug (Part D) coverage as part of the plan. Knowing the difference between a “MA” and a “MAPD” is explained later.
Travel
Advantages	Disadvantages
More and more, Medicare Advantage plans are starting to get more flexible with travel. For example, some offer foreign travel emergency coverage. Original Medicare doesn’t offer that.	One of the biggest disadvantages of Medicare Advantage plans is the restrictions it places when you’re traveling (both in the U.S. and abroad).
In addition, some Advantage plans are starting to offer programs that allow you to make your plan portable to other states and counties. And PPO plans are offering nationwide networks.	If you enroll in an HMO Advantage plan, then you will only have emergency (including urgent care) coverage outside of the network of doctors and hospitals.
Bottom line: Medicare Advantage plans are becoming more flexible with travel, both in the US and abroad.	In addition, some Advantage plans are starting to offer programs that allow you to make your plan portable to other states and counties. And PPO plans are offering nationwide networks.
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