Which parts of Medicare do you need? What do they cover? How much do they cost? How do you get coverage? Many people have these same questions, and in this blog series, we are taking a closer look at Medicare to make it easier for you to navigate the journey.
We’ll cover Part A and B — also known as Original Medicare — as well as Medicare Advantage coverage (Part C), Medigap plans and prescription drug coverage (Part D). We’ll also address how and when you should sign up for Medicare and how to help a loved one understand their Medicare options.
Navigating the Medicare system would be much easier if, when you turned 64, a notice came in the mail telling you that you’ve been automatically enrolled in a training class on the topic. In the classes, you could learn many things, including when to enroll, how your current health care coverage translates to Medicare plans, the vocabulary that will help you understand Medicare, and things to consider when choosing a plan.
Unfortunately, Medicare School doesn’t exist, but we’re going to outline some basics of Medicare coverage to help get you started. There are four parts of Medicare — Parts A, B, C and D. Each part offers different coverage. Without knowing the essentials, it can be confusing and difficult to decide what you need, as well as what may not be necessary, for your particular situation.
In this post, we’ll cover “Original” or “standard” Medicare — also known as Part A and Part B. It covers 80 percent of medical costs, leaving the additional 20 percent to be paid by you. Original Medicare does not cover certain things, however, including prescription drugs.
Let’s take a deeper dive into each part of Original Medicare to help you better understand coverage and how to sign up.
Both Medicare Part A and Part B are provided by the U.S. federal government, and you may qualify for them if one of the following applies to you.
Some people are automatically enrolled in Medicare. If this is the case for you, you will receive your Medicare card in the mail three months before your 65th birthday or in your 25th month of disability — whichever applies to you.
If you meet the following criteria, you may have to sign up yourself for Medicare Part A and/or Part B.
You don’t need to sign up for Medicare again each year. But each year you’ll have a chance to review your coverage and change plans. If you are already enrolled in Original Medicare, you will receive a “Medicare and You” handbook in the mail or electronically if you’ve signed up to be paperless.
Medicare Part A covers medically necessary services and supplies to treat a disease or condition. It is also known as hospital insurance, as it covers any medical care that requires an overnight stay in the hospital.
Some services may only be covered under certain conditions or in a particular medical setting. In general, however, Medicare Part A covers:
Medicare Part A also covers annual checkups and many preventive services without requiring copayments. It is always important to talk to your doctor to learn why services or supplies are needed, and to ask if Medicare will cover them.
Enrolling in Part B is your choice — you don’t have to sign up for it if you don’t want to. It typically has a monthly premium that is deducted from your Social Security check.
Most people receive a “premium-free Part A.” You usually do not have to pay a monthly premium for Medicare Part A coverage if you or your spouse paid Medicare taxes when you were working.
You can get premium-free Part A at 65 if:
If you’re under 65, you can get premium-free Part A if:
If you are not eligible for a premium-free Part A, you can still buy the coverage from Medicare. In most cases, if you choose to buy Part A, you will need to also carry Medicare Part B and pay a premium for both.
The Social Security Administration can provide more information about the Part A premium.
Once you’ve met your deductible, you’ll usually pay 20 percent of the Medicare-approved amount for several medical needs, such as:
Medicare takes into account the modified gross income reported on your IRS tax return from two years ago. If it is above a certain amount, you may have to pay an Income Related Monthly Adjustment (IRMAA), which is a charge added to your standard premium. Social Security will contact you if you have to pay more due to your income, and the amount you pay can change each year if your income changes.
In summary, Original Medicare takes care of you when there’s an emergency, but most routine checkups and common items like glasses or prescription drugs aren’t covered.
If Medicare Part A and Part B do not provide enough coverage for your needs, you may want to consider a Medicare Advantage plan — also known as Part C. Medicare Advantage plans are offered by private health insurance companies like Highmark, not by the federal government.
If you have a member service question that involves personal health or insurance information, do not use the "comments" feature; please call the number on the back of your Member ID card.