Medicare’s Annual Enrollment Period is here:
October 15 – December 7
Reevaluate your current coverage to see if it’s still a good fit for you. If not, Medicare beneficiaries can make the following changes during this period:
- Switch from Original Medicare to Medicare Advantage
- Switch from Medicare Advantage to Original Medicare
- Change Medicare Advantage plans
- Enroll in or drop a Medicare Part D plan
- Change Medicare Part D plans
Still have questions? Learn more about the Annual Enrollment Period and other enrollment periods for Medicare.
Original Medicare is comprised of two parts:
- Part A, which offers hospital coverage
- Part B, which offers medical coverage
In addition to that, there are two other Medicare products offered by private insurers:
- Part C, also called Medicare Advantage
- Part D, which offers prescription drug coverage
Some coverages may be free, while others cost a monthly premium to maintain coverage. Understanding the different parts of Medicare can help you know which coverages you have — and which coverages you might want to add on.
- An Overview of Medicare Parts
- Medicare Part A: Hospital Coverage
- Medicare Part B: Medical Coverage
- Medicare Part C: Medicare Advantage Plans
- Medicare Part D: Prescription Coverage
- Another Option: Medicare Supplement Plans
- What Medicare Doesn’t Cover
- Medicare vs. Medicaid
- What to Consider For Your Medicare Plan
An Overview of Medicare Parts
|Coverages||Part A||Part B||Part C||Part D|
|Hospital and inpatient services||Yes||No||Yes||No|
You are be eligible for Medicare if you’re 65 or older, but even if you are not yet 65 years of age, you may also be eligible if you have a certain disability or serious health condition, such as end-stage renal disease.
Medicare Part A and Part B are known as Original Medicare. These work in tandem to provide complete healthcare coverage. If you already get Social Security benefits, you may automatically be signed up for Medicare Parts A and B.
To gain additional coverage, some people choose to purchase Part C or Part D Medicare plans, or both. Both types of plans are run by private insurance companies that have been approved by Medicare. Part C, also known as Medicare Advantage, combines hospital, medical, and usually prescription drug coverage. These plans may also offer some additional benefits like dental, hearing, and vision coverage. Most Part C policies include Medicare Part D prescription drug coverage, but not all as Part C plan benefits vary by insurer.
Those specifically seeking more prescription drug coverage to add to their Original Medicare plan may benefit from purchasing Part D coverage.
Medicare Part A: Hospital Coverage
Medicare Part A offers hospital and inpatient coverage. This means it includes things like:
- Hospital stays
- Care in a skilled nursing facility
- Nursing home care
- Hospice care
- Some home health care
Part A is part of Original Medicare, meaning it is a standard coverage included when you sign up for Medicare. Those who have been employed, or are married to someone who has been employed, and have paid at least 10 years of Medicare taxes typically receive Part A coverage for free. Otherwise, you may need to pay either $274 or $499 a month in 2022, depending on the length of time you or your spouse worked and paid Medicare taxes.
You may get Part A coverage automatically when you sign up for Social Security or Railroad benefits, as that application also doubles as your Medicare application. However, if you don’t get benefits or are applying earlier than age 65 because of a disability, you can sign up at your local Social Security office or by calling the national hotline at 1-800-772-1213 (TTY 1-800-325-0778). Keep in mind that if you don’t get Medicare when you’re first eligible, you may have to pay a late enrollment penalty based on how long you put off signing up.
To take advantage of Medicare Part A services, you must go to a facility that accepts Medicare. For example, if you go to a covered hospital with Part A coverage, you may pay a $1,556 deductible. Medicare would then cover everything else for up to 60 days. After day 60 of being in the hospital, you may then have to pay $389 per day. If you go somewhere out of network, however, you may have to pay for your services completely out of pocket.
Medicare Part B: Medical Coverage
Medicare Part B is the medical coverage part of Original Medicare. That means it covers things like:
- Doctors’ visits
- Outpatient care
- Durable medical equipment (like wheelchairs or walkers)
- Preventative services (like vaccines or wellness visits)
- Mental health services
- Ambulance services
Unlike Part A, which is free for some individuals, everyone pays for Part B. The standard cost is $170.10 in 2022, but it can be as high as $578.30 if you earn over $500,000 a year in income. Like with Part A of Medicare, you may be enrolled in Part B automatically if you have signed up for Social Security or Railroad benefits. If this is the case, your premium may be automatically deducted from your benefits. Otherwise, you may receive a monthly bill.
Signing up for Part B is the same process as Part A because you typically enroll in both at the same time. Like with Part A, you may also be subject to late enrollment fees if you don’t sign up when you’re first eligible. For Part B, this penalty is a 10% increase in your monthly premium for every 12 months you delayed, and this increased premium lasts for as long as you have Part B.
To have your Medicare Part B coverage kick in, you also need to pay a deductible the first time you use your services. The deductible for 2022 is $233. After you pay this amount, your insurance should cover 80% of your expenses, as long as you’re receiving care from an in-network provider. In addition, there is no cost for routine preventive services as long as you’re in network. If you see an out-of-network doctor, however, you may be responsible for covering the entirety of the bill.
Medicare Part C: Medicare Advantage Plans
Unlike Parts A and B, which are offered by the federal government, Medicare Part C is offered exclusively by private insurance companies. These plans — also known as Medicare Advantage plans — combine the benefits of Parts A and B, and usually Part D, into a single coverage. Insurance companies offering Part C are approved by Medicare, meaning they have to follow guidelines set by Medicare.
Medicare Advantage plans cover everything that Parts A and B do, but with a few extra benefits. These can vary depending on the specific plan you choose, but may include:
- Fitness and wellness programs
- Vision coverage
- Hearing coverage
- Dental services
- Transportation to doctor’s visits
- Over-the-counter drugs
Those looking to enroll in Medicare Part C can choose between the following types of plans:
- Health Maintenance Organization (HMO): Requires you to get services and care from providers in your plan’s specific network; visiting another provider means you may not be covered.
- Preferred Provider Organization (PPO): Gives you more flexibility to see out-of-network providers, but seeing providers in network is cheaper.
- Private Fee-for-Service (PFFS): This plan has a set amount for how much you pay for each service you need as long as you go to an in-network doctor. There’s no guarantee your plan covers out-of-network expenses.
- Medical Savings Account (MSA) Plan: This plan works like a special savings account that lets you pay for medical expenses from this account. Because of that, you can use it to pay for any medical service, in network or not.
Medicare Part D: Prescription Coverage
Medicare Part D offers coverage for prescription drugs, which are often not covered by Original Medicare unless given during surgery or an emergency.
Like Medicare Part C, it is offered exclusively by private insurance companies. You can choose a standalone plan to pair with your Original Medicare benefits, or you can choose it as part of a Medicare Advantage plan.
Costs for Part D vary depending on where you live, and you also may face additional charges if you have a higher income. For example, if you make over $500,000 a year, there’s an extra $77.90 added to your plan’s monthly premium in 2022.
Each unique plan has a list of specific drugs it covers, called a formulary. While drugs may be different between plans, all plans separate prescriptions into 4 different cost tiers:
- Tier 1: Usually includes generic drugs and has lower prices
- Tier 2: Usually preferred, brand-name drugs with slightly higher prices
- Tier 3: Usually non-preferred, brand-name drugs with even higher prices
- Specialty tier: Drugs that are expensive or rare
While many medications are covered, Part D generally doesn’t cover:
- Drugs for weight gain/loss
- Drugs for sexual dysfunction
- Drugs for relief of coughs and colds
- Non-prescription drugs
- Fertility drugs
- Hair regrowth drugs
Another Option: Medicare Supplement Plans
If you don’t think Original Medicare offers quite enough coverage, but you don’t want to switch to a full Medicare Advantage plan, you might consider a Medicare Supplement Plan, also known as Medigap. These plans are offered by private insurance companies to help pay for some of the “gaps” in Original Medicare coverage. For example, it can help you with costs related to:
But even though Medigap provides coverages for some things not included in Parts A and B, it still generally does not offer out-of-network coverage.
The cost of a Medigap plan varies depending on a number of factors. Insurance companies generally price their policies in 3 ways:
- Community-rated/no age-rated: Premiums aren’t based on age, so everyone pays the same amount
- Issue-age-rated: Premiums are based on how old you are when you buy the policy. If you can lock in a low rate when you’re younger, you may save money as you age because your premium will not change
- Attained-age-rated: Premiums are based on your current age, meaning they get more expensive as you get older
What Medicare Doesn’t Cover
Original Medicare is not comprehensive. Here is what Parts A and B do not cover:
- Dental care
- Eye exams
- Hearing aids
- Routine foot care
- Prescription drugs
Some of those coverages could be part of a Medicare Advantage plan, and prescription drug coverage in particular is also available through Medicare Part D. If you don’t want to enroll in a Medicare Advantage plan or if your plan doesn’t offer coverage for a specific need, you may be able to get standalone insurance. For example, you could buy dental or vision insurance directly from an insurance provider to get coverage.
Medicare vs. Medicaid
While Medicaid has a similar sounding name to Medicare, it’s a completely different type of insurance. Medicaid is a government program offering health insurance coverage to low-income adults, children, pregnant people, people with disabilities, and older adults. While Medicare is managed on the federal level, Medicaid is regulated by individual states, meaning eligibility requirements and benefits vary greatly depending on which state you live in.
With Medicare, you have to pay for your Part B premium, as well as any additional coverages you’d like to add on. Medicaid, on the other hand, is usually free or extremely low cost, as it’s meant to help people who are struggling financially.
It’s possible that you may be eligible for both Medicare and Medicaid if you’re over 65 and your income is low enough. If that’s the case, then Medicare would pay a portion of your medical bills first; then, Medicaid may cover some or all that is left.
What to Consider For Your Medicare Plan
For many people, Original Medicare is enough for their needs. Those with specific health needs or concerns, though, may benefit from more robust coverage through Part C or Part D. The biggest factor to consider is your health. Do you anticipate having a lot of health needs over the coming years? For example, are you a diabetic who needs to take insulin every day? If so, then having a Part D supplemental plan could help you save on medication costs. However, if you’re in relatively good health and don’t anticipate having a lot of medical bills, then you may not want to pay an extra monthly premium.
Network availability is another concern. Original Medicare is accepted by many hospitals and doctors across the country, but Medicare Advantage often has its own network of providers you may need to stick to. If you see a doctor outside of that network — even if they accept normal Medicare — you may have to pay the bill out of pocket.