Medicare Part A: Hospital Insurance

What does Medicare Part A cover?

Part A covers services that hospitals provide, such as the room, nursing services, and supplies for an inpatient stay at the hospital. Medicare Part A will pay for a stay in a skilled nursing facility, as well as home health and hospice care provided they are medically necessary.

How does Medicare Part A work?

Part A will not cover all of your hospital costs. There is a deductible of $1,364.00 per benefit period in 2019, which you must pay before Medicare will cover any expenses. If you suffer a long hospitalization, you will also have to pay a daily coinsurance fee. This is $341 per day for days 61 through 90, and it rises to $682 per day for your 91st through 150th day. However, you will only be responsible for your Part A deductible if you are hospitalized for up to 60 days.

How much Medicare Part A cost?

For most people, there is no monthly premium for Part A coverage. It is funded by Social Security tax you and your employers have already paid.

Medicare Part B: Medical Insurance

What does Medicare Part B cover?

Part B covers services that doctors provide, both in the office and in the hospital. It also pays for other medical services and supplies for an inpatient stay that are not covered by Part A. Part B also covers outpatient hospital services and long-lasting medical equipment like wheelchairs and walkers.

How does Medicare Part B work?

Part B works like most health insurance plans. You pay a monthly premium, which usually is taken out of your Social Security check. You must meet an annual deductible of $185.00 in 2019 - before your Part B benefits kick in. After that, Medicare generally pays 80% of the charges it approves. You typically are responsible for paying the remaining 20% or applicable copayment of the Medicare approved amount. You are responsible for paying 45% of the cost of most outpatient mental health care, and 20% of the Medicare approved amount for blood after the first 3 pints.

How much Medicare Part B cost?

Part B is optional. Depending on your income, you pay a monthly premium based on the chart below.

Medicare Part C: Medicare Advantage Plans

What is Medicare Part C?

Most people choose additional insurance to pay the medical expenses not covered by Medicare. One option is Medicare Part C, also known as Medicare Advantage plans. These plans are offered by private insurance companies that contract with the federal government. If you choose a Medicare Advantage Plan, your Medicare Part A and Part B will be administered by the plan, which means you have one source for your health care coverage.

These plans may give you more benefits than Medicare alone, including coverage for extra days in the hospital and prescription drugs. Some plans also offer vision, dental, and hearing benefits.

How much Medicare Part C cost?

Depending on the plan you choose and where you live, you may have to pay a monthly premium, which is usually less expensive than Medicare Supplement Plans. To help save on the cost of coverage, plans may use provider networks.

Medicare Advantage Plan premiums and benefits vary widely from company to company. It’s smart to shop around.

Medicare Part D: Prescription Drug Coverage

What is Medicare Part D?

Once you are entitled to Medicare Part A or enrolled in Part B, you can enroll in the Prescription Drug Plan (PDP) of your choice (as long as you reside permanently in its service area). PDPs are offered by private companies and help cover the cost of prescription drugs.

How much Medicare Part D cost?

Benefits and premiums vary by plan provider and your geographic region. Medicare’s standard benefits pay 75% of costs up to $3,820 after you meet a $415 deductible. They pay approximately 95% of costs during the catastrophic coverage. Enhanced benefits may be available. Prescription drug coverage is often included in Medicare Advantage plans.

Catastrophic Coverage

What is Catastrophic Coverage?

Catastrophic Coverage assures you only pay a small coinsurance amount or copayment for covered drugs for the rest of the year.

How do I qualify for Catastrophic Coverage?

Once you’ve spent $5,100 out-of-pocket in 2019, you’re out of the coverage gap. Once you get out of the coverage gap (Medicare prescription drug coverage), you automatically get “catastrophic coverage”.

Medicare Assignment Charges

What are Medicare Assignment Charges?

Each year, Medicare has a list of charges it will cover for hospital and medical services. These are called Medicare assignment charges. Most doctors accept these assignments, which means that they will charge you the Medicare approved rate.

What if my physician does not accept Medicare Assignment Charges?

If you use a physician who does not accept assignments, he or she can charge more than the Medicare approved rate. In that case, you will be responsible for the usual Medicare deductible and coinsurance costs plus the difference between Medicare’s approved amount and the billed amount. The billed amount is limited to a maximum of 15% over Medicare’s approved charge.

To find out if your doctor accepts assignments you can call MEDICARE Customer Service
1-800-663-4227 (TTY: 1-877-486-2048)
24 hours a day | 7 days a week

If your doctor doesn’t accept assignments, you can switch to another doctor who does or you can purchase a supplemental insurance plan that will cover all or part of these additional charges.