Why you need to know about parts of Medicare and what they cover
What you need to know about the different parts of Medicare and what they cover? Find out here on this episode. Then download your FREE Queer Money Kickstarter, a 9-step Guide to Kickstart Your Journey to Financial Independence.
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How to understand the parts of Medicare and what they cover
On this Queer Money®, we’re diving into a topic as essential as your morning coffee and as complicated as setting up your smart TV: Medicare. It might sound complicated, but on Queer Money® episode #571, we’re here to make sense of it all—minus the bureaucracy headache.
Medicare—your healthcare alphabet soup. Medicare is divided into four main parts: Part A, Part B, Part C, and Part D. Each part provides specific types of coverage to meet different healthcare needs. Part A is your hospital safety net, Part B keeps doctor visits and checkups covered, Part C is the all-in-one buffet with extras like dental, and Part D takes care of those pesky prescription costs. Let’s break it down and get you Medicare-savvy in no time!
Part A of Medicare is hospital insurance. What It Covers: Inpatient hospital stays, skilled nursing facility care (short-term, after a hospital stay), hospice care, and home health care (limited). Who Pays: Most people don’t pay a premium if they or their spouse worked and paid Medicare taxes for at least 10 years. There are deductibles and coinsurance costs.
Part B of Medicare is medical insurance. What It Covers: Doctor visits, outpatient care, preventive services (e.g., screenings, flu shots), medical equipment (e.g., wheelchairs, walkers), and mental health services. Who Pays: Monthly premiums (adjusted based on income), an annual deductible, and a 20% coinsurance for most services after meeting the deductible.
Part C of Medicare is Medicare Advantage. What It Covers: It combines Part A and Part B coverage (sometimes Part D as well), often includes additional benefits like vision, dental, and hearing, and is managed by private insurance companies approved by Medicare. The Key Features are: You’ll typically use a network of providers (HMO or PPO plans), premiums vary by plan, and Out-of-pocket costs are often capped.
Part D of Medicare is prescription drug coverage. What It Covers: It helps cover the cost of prescription medications and includes many vaccines and some shots. Who Pays: Monthly premiums, copayments, or coinsurance for prescriptions and plans vary in cost and the specific drugs they cover.
An additional option is Medigap (Medicare Supplement Insurance). Private companies sell it to cover gaps in original Medicare (Parts A & B), such as copayments, coinsurance, and deductibles. It does not work with Medicare Advantage plans
Some key notes are as follows: Original Medicare: Includes Part A and Part B, offered directly by the federal government. Medicare Advantage (Part C): Alternative to Original Medicare, offered by private insurers, and may include extra benefits. Enrollment Periods: It is essential to sign up during your Initial Enrollment Period or face late penalties for Parts B and D
Some factors to consider when choosing a plan are as follows: One is healthcare needs. Frequent doctor visits or specialized care: Original Medicare with Medigap might be better since you can see any provider nationwide. Minimal healthcare needs: Medicare Advantage could offer low premiums with additional perks. Two is prescription drug needs. Review your current medications against Part D or Medicare Advantage formularies to ensure coverage and affordability. Three your Budget. Fixed vs. Variable Costs: Original Medicare + Medigap offers predictable costs; Medicare Advantage may save on premiums but could lead to higher out-of-pocket service expenses. Fourth is travel. If you travel frequently or live in multiple states, Original Medicare with Medigap provides nationwide coverage, whereas Medicare Advantage is often limited to local networks. Fifth is additional benefits. If you need vision, dental, or hearing coverage, Medicare Advantage often includes these, whereas Original Medicare does not. The sixth is the out-of-pocket maximum. Medicare Advantage plans have a cap on annual out-of-pocket costs, while Original Medicare does not.
Some tools to help you choose the best plan are the Medicare website (Medicare.gov), which offers tools to compare plans in your area and to contact your local State Health Insurance Assistance Program (SHIP) for free counseling.
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