The ABC'S Of Medicare

Michael T. Braden, August 27, 2024 FOUR PARTS OF MEDICARE

The ABC Of Medicare Is A Brief Re-Cap OF The Basics Of Medicare

THE ABC's OF MEDICARE

MEDICARE PART A 

Pays for hospital stays, skilled nursing care, blood products, and hospice care. About 99% of people enrolled in Medicare Part A will never have to pay a premium for Medicare Part A coverage because of the Medicare Taxes they paid through payroll deductions throughout their working careers. The Medicare Deductible for Medicare Part A is $1,632.

MEDICARE PART B 

Covers outpatient services such as preventive care, physician visits, laboratory tests, diagnostic imaging, outpatient surgery, durable medical equipment, chemotherapy, radiation therapy, Drug Injections for various conditions, and more.

Everyone who enrolls in Medicare Part B must pay their monthly Medicare Part B Premium and their Annual Part B Deductible, regardless of whether they participate in Original Medicare, a Medicare Advantage Plan, or even if they choose Original Medicare with a Medicare Supplement policy. Your Medicare Part B premium can be paid by Credit Card, Direct Bill, EFT Transfers, or can be paid from your monthly Social Security Benefits.

For 2024, the monthly Medicare Part B premium is $174.70, and the Annual Part B deductible is $240. This means you must meet the annual Deductible before Medicare begins to pay.

Both Medicare Part A and Medicare Part B are 80% government-paid, with the remaining 20% borne by the beneficiary or patient. With Original Medicare, you are free to choose a Doctor or Hospital that accepts Medicare Terms for payment. (Approximately 94% of all Doctors accept Medicare.

MEDICARE PART C 

Medicare Part C is commonly referred to as Medicare Advantage (MA). Medicare Advantage plans are offered and managed by private, for-profit insurance companies instead of the Government. Instead of being responsible for paying 20% of all services, your insurance company will have specific Copayments and Coinsurance that you must pay for services throughout the year.

M/A plans are either HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) networks. With these plans, you must use the Doctors and Hospitals listed in their network to receive full coverage for any procedure.  

The company decides which services they will pay for, and, in fact, they are well known for denying claims and coverage; they do not disclose this in their TV commercials or in marketing flyers, postcards, or brochures.

Medicare Advantage plans each have their own MOOP.  MOOP stands for Maximum-Out-Of-Pocket Expense. This is the amount you must reach before your insurance company pays for all of your healthcare services.  

MEDICARE PART D 

Covers Prescription Drugs. Because there is no prescription drug coverage with Original Medicare (except for those drugs and medications that are provided during a hospital stay).  

On October 8, 2003, President George W. Bush signed Medicare Prescription Drug coverage into law.

Medicare Part D  covers retail prescription drugs for Medicare beneficiaries through unique, stand-alone drug insurance plans. 

You pay a monthly premium to join any Medicare Part D Prescription Drug plan available in your area that fits your needs the best. Choose the Plan that saves you the most money on your prescription medications.

These plans range from $0.00 - $169 per month. We strongly believe that it is best to work with an experienced Medicare Broker, such as Braden Medicare Insurance, to find the best plan at the lowest cost for your individual needs.

Each Insurance Company offering Medicare Part D Prescription Drug Plans must have at least 1 Plan that provides the Senior Savings Model, which caps the monthly maximum you can spend on Insulin at $35.00. 

You should review your plan annually, and you may change your plan during the Medicare Annual Enrollment Period (AEP) in the fall. The new plan will begin on January 1st every year.