The parts of Medicare

PART A: Hospital insurance

  • Health insurance provided by the federal government
  • Covers inpatient hospital care, skilled nursing facility, hospice, surgery and home health care
  • You pay a deductible per benefit period for inpatient hospital stays
  • Most people should enroll at age 65, even if they have other insurance
  • Most people do not pay a premium

PART B: Medical insurance (doctor and lab)

  • Health insurance provided by the federal government
  • Covers doctor care, durable medical equipment, outpatient surgery, and chiropractic care
  • You pay an annual deductible for outpatient services
  • If you have employer coverage, check with your employer to see if you should also have Part B
  • Most new enrollees pay a standard monthly premium which can be deducted from your Social Security check or billed directly to you
  • Higher-income beneficiaries may pay an Income Related Monthly Adjustment (IRMA) amount in addition to the standard premium

PART C: Medicare Advantage

  • A type of Medicare health plan offered by a private insurance company that contracts with Medicare
  • Responsibility to administer your Medicare Part A and Part B benefits is transferred to the plan
  • Monthly premiums vary. You pay this in addition to your Part B premium.
  • You usually pay a copayment or coinsurance for covered services; each plan can charge different out-of-pocket costs and have different rules for how you get services
  • Renewal is not guaranteed
  • Not required to provide Wisconsin mandated benefits as supplement plans are

Part D: Prescription drug plan

  • Optional benefit offered directly by private insurance companies
  • Each plan has a list of covered drugs (formulary) and may have a pharmacy network
  • Monthly premiums vary by plan
  • There are extra costs for delaying enrollment when eligible for Medicare Part A and B, unless you’re switching from other creditable drug coverage or qualify for extra help
  • Higher-income beneficiaries may pay a Part D income-related monthly adjustment (IRMA) amount in addition to the monthly plan premium
  • Often used in combination with Original Medicare and a supplement plan

Medicare supplement plan

Medicare Part A and Part B do not cover all expenses. A select plan like Health Tradition 65Plus Platinum helps to close Medicare coverage gaps.  Supplement or Select plans can also be called “Medigap” plans.

  • Available from private insurance companies and regulated by the State of Wisconsin
  • Plans pay some or all of Medicare Part A and B deductibles
  • Plans pay some or all of the coinsurance Medicare does not pay
  • Guaranteed acceptance during your open enrollment “window”
  • Guaranteed renewable for life

 

Additional resource
Download the glossary prepared by Centers for Medicare & Medicaid Services (CMS) that explains insurance concepts and terms.

 

This is an advertisement for insurance. In offering Medicare Select insurance, neither Health Tradition Health Plan nor its agents are connected with Medicare.

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