What is Medicare?

Subtitle: 

In this section:

  • What are the 4 parts of Medicare?
  • Am I automatically enrolled in Medicare?
  • Does Medicare provide all the coverage I need?

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Medicare is basic health insurance provided by the Federal government for people 65 and older, and people under 65 who meet certain criteria.

Medicare consists of 4 separate parts:

  • Part A (Part of Original Medicare offered by the Federal government)
  • Part B (Part of Original Medicare offered by the Federal government)
  • Part C (Additional coverage offered by private insurance companies)
  • Part D (Drug coverage offered by private insurance companies)

Part A: Hospital visits

Part A covers hospital stays, nursing home stays, some home care, and hospice care. Most people don’t pay a monthly premium for Part A, but there is a deductible.

What's covered under Part A?

What's covered:

  • Hospital expenses for inpatient hospital stays (e.g. meals, supplies, tests, accommodations)
  • Skilled nursing facility care
  • Nursing homes
  • Hospice care
  • Some part-time, medically necessary home health care (physical, occupational, and speech therapy)
  • Some medical equipment (e.g. walkers and wheelchairs)
  • Prescription drugs taken as part of inpatient hospital or skilled nursing facility treatment

What's not covered:

  • Routine eye exams and most eyeglasses
  • Dental care and dentures (with only a few exceptions)
  • Outpatient prescription drugs prescribed by your doctor
  • Gym memberships or fitness classes
  • Weight management programs
  • Routine hearing tests
  • Custodial care (help with bathing, dressing, using the bathroom, and eating) at home or in a nursing home
  • Long-term care (for information about paying for long-term care, visit longtermcare.acl.gov or eldercare.acl.gov
  • Acupuncture
  • Most chiropractic services

What does Part A cost?

Premium: $0

  • If you or your spouse paid Medicare taxes while employed, like most people, Part A is premium-free.
  • Otherwise, you pay $458 per month.

Deductible: $1,408 per Benefit Period

  • Hospital stays have a deductible (skilled nursing facility stays do not).
  • Deductible must be paid before Medicare begins paying for your Medicare Part A related costs.
  • Deductible may need to be paid for each hospital stay depending on how close together they are because Original Medicare measures hospital stays by benefit periods.

Benefit Period is the timeframe for coverage beginning the day you enter a hospital or skilled nursing facility and ending when you’ve gone 60 days in a row without receiving any inpatient hospital care or care in a skilled nursing facility.

  • There is no limit to the number of Benefit Periods.
  • You must pay the Medicare Part A deductible for each new Benefit Period.

Lifetime Reserve Days

A provision of Original Medicare; you have a total of 60 reserve days for use during your lifetime that Medicare will pay for when you are in a hospital for more than 90 days.

Part B: Medical services

Part B covers medical services such as doctor visits and outpatient care. You pay a monthly premium for Part B, plus additional medical service costs.

What's covered under Part B?

What's covered:

  • Doctor office visits (primary care and specialists)
  • Test and laboratory services
  • Outpatient care
  • Ambulance and emergency services
  • Limited prescription drug coverage, including injections received in a doctor's office, certain oral cancer drugs, and certain drugs you get in a hospital outpatient setting
  • You can see any Medicare provider, no referrals required

What's not covered:

  • Routine eye exams and most eyeglasses
  • Dental care and dentures (with only a few exceptions)
  • Outpatient prescription drugs prescribed by your doctor
  • Gym memberships or fitness classes
  • Weight management programs
  • Routine hearing tests
  • Custodial care (help with bathing, dressing, using the bathroom, and eating) at home or in a nursing home
  • Long-term care (for information about paying for long-term care, visit longtermcare.acl.gov or eldercare.acl.gov
  • Acupuncture
  • Most chiropractic services

What does Part B cost?

Premium: $144.60 per month (depending on income)

Your premium is deducted from your Social Security payments automatically (once you sign up for Part B). If you do not receive Social Security payments, you will get a Medicare bill every 3 months.

Deductible: $198 per year

Coinsurance: 20%

After you reach the deductible, you pay 20% (called coinsurance) of the Medicare-approved amount for each specific procedure. Medicare Advantage (Part C) plans can cover this remaining 20%.

Part C: Medicare Advantage plans

Part C covers all the benefits of Part A and Part B plus additional benefits and services. The cost of a Part C plan varies depending on the plan.

What's covered under Part C?

Part C covers all the benefits of Original Medicare (Part A and Part B), plus additional benefits that Original Medicare doesn’t cover and the option to include prescription drug (Part D) coverage. Many people choose to add Part C because it provides more complete coverage than just Original Medicare.

  • All the benefits of Original Medicare (Part A and Part B)
  • Routine eye exams
  • Routine hearing exams
  • Prescription drug coverage (available with many, but not all, Part C plans)

What does Part C cost?

Premium, copays, and deductible vary depending on your plan.

Compare CarePartners plans to see what these costs may be.

When you join a Medicare Advantage plan (Part C), you must continue to pay your Medicare Part B premium.

Part D: Prescription drugs

Part D covers prescription drugs. The cost of a Part D plan varies depending on the type of plan you choose. Part D can be included with a Part C plan or purchased separately as a stand-alone Part D plan.

What's covered under Part D?

Part D provides coverage for prescription drugs.

What does Part D cost?

Premium, copays, and deductible vary depending on your plan.

There are two ways you can add Part D to your coverage:

  • Option 1: As part of a Medicare Advantage Plan (Part C). CarePartners of Connecticut offers Medicare Advantage plans (Part C) that include Part D prescription drug coverage, so you can have all the coverage you need in one plan.
  • Option 2: As a separate plan that is added to Original Medicare (Part A and Part B).

You are not automatically enrolled in Medicare!

Many people think you automatically get Medicare (Part A and Part B) when you turn 65, but that’s not true. In order to get Medicare coverage, you must enroll through the Social Security Administration. You can enroll on the Social Security website, by calling Social Security at 1-800-772-1213, or by visiting your local Social Security office in person.

Find your local Social Security office here.

Add Part C and Part D for complete coverage.

Once you sign up for Medicare (Part A and Part B) you will want to consider adding Part C and Part D in order to have complete coverage. Many people find that Original Medicare (Part A and Part B) does not provide enough coverage on its own. Medicare Advantage plans, such as CarePartners of Connecticut, offer Part C plans that include Part D coverage so you can have all your coverage in one plan.

Next Section: When do I sign up for Medicare?