Medicare Part A is automatically assigned at age 65, is usually free to the eligible individual (see Part A costs), and provides hospital coverage after a deductible for up to 60 days, and for a per day copay thereafter.
Medicare Part B provides generally 80% coverage for medically necessary doctor’s visits, preventive care, and outpatient services. To determine your Part B premium, see: Part B Costs. If you have medical coverage through an employer with less than 20 employees, you must elect Part B when eligible as Medicare will be the primary payor (see: Coordination of Benefits).
Medicare Part C “Advantage” Plans are private plans offered by CMS-approved insurance companies that coordinate coverage with Parts A and B to provide coverage for copays (some plans also include prescription drug coverage). Advantage plans must be renewed every January as rates and benefits change; if you are enrolled in an Advantage plan you can change your plan/insurer each year during the Annual Election Period (AEP) which is 10/15-12/7.
Medicare Supplement (“Medigap”) Plans are private plans offered by CMS-approved insurance companies that pay for the deductibles and coinsurance not covered by Medicare Parts A and B. These are standardized policies which offer the same basic benefits regardless of the insurer or state. Supplemental plans can be elected instead of Part C Advantage plans to pay for the gaps in coverage A and B don’t provide (see Choosing a Medigap Policy). Benefits do not change each year with Supplemental plans. Plan F is the richest plan available as it covers medical at 100% (including Part B “excess” charges), does not require referrals, and has no insurer-network restrictions (providers nationwide only must accept Medicare). Plan F is only available to those eligible for Medicare before 2020, however. Plan G is the same as F except that the plan does not cover the Part B deductible each year ($233 in 2022). If Supplemental coverage is elected, we recommend adding a Prescription Drug Plan (PDP) under Part D.
Medicare Part D provides prescription drug coverage through private insurers CMS approves in each state. Each year between October 15 and December 7th (the AEP) you can change your Part D Prescription Drug Plan (PDP) for the following year. It is important to reevaluate your PDP each year to ensure you have the best card for your needs, as your Rxs can change, drug formularies change, premiums change, and new cards are introduced into the market. Complete our online PDP Analysis Request Form or go to www.medicare.gov to find a PDP to fit your needs. Note: most people only pay the insurer’s PDP premium for Part D coverage; however, higher income beneficiaries are charged an income-related monthly adjustment amount (IRMAA) from Social Security in addition to the insurer premium, see here: Part D Costs.
Contact us to for more information or to receive a quote.
- 5 Things to know about Medicare
- 2022 PDPs in DE, NJ, NY, PA
- 2022 PDP Quote Request Form (online)
- Apply for Medicare Part B
- Choosing a Medigap Policy
- Medicare & You 2020
- Medicare & You 2021
- Medicare & You 2022
- Medicare Costs (Parts A, B, D)
- Medicare and Group Health Insurance
- Medicare Coordination of Benefits
- Medicare Coordination of Coverage
- Medicare Costs-at-a-Glance
- Medicare Part D Plan Benefits
- Medicare Part D Standard Benefit 2022
- Medicare Part D Standard Benefit 2021
- Medicare Preventive Services
- Medicare Provider Search
- Medicare Supplement (‘MediGap’)
- Medicare Supplier Search
- Medicare Top FAQs
- Registering with MyMedicare.gov
- Using Medicare.gov to compare, select and apply for your PDP (video)
- Using Medicare.gov to compare, select and apply for your PDP (instructions)
- What Medicare Covers
- Who Pays First