By: Julianne F. Andrews, MBA, CFP®, AIF®

Whether you’ve officially retired or are still working full time, it’s possible your health insurance options are changing. Depending on your age or health status, you may soon be qualified for Medicare. While you’ve likely heard of it before, we’re breaking down what exactly it is, who Medicare benefits and what each Medicare part covers.

What Is Medicare?

Medicare is a government-funded national health insurance program that was established in 1966. It is designed to offer coverage to individuals including:1  

• Those who are 65 or older
• Individuals under 65 with qualifying disabilities
• Individuals with End-Stage Renal Disease (ESRD)

Medicare is broken down into several parts that cover specific services. While Part A and Part B are part of the “original” Medicare plan, Parts C and Part D offer optional additional coverage.

Part A: Hospital Insurance

Part A is considered hospital insurance.

As such, it covers hospital-related expenses such as:2

• Inpatient hospital care
• Skilled nursing facility costs
• Hospice
• Lab tests
• Surgery
• Some home health care services

Most beneficiaries don’t pay Part A premiums out of pocket if they or their spouse paid Medicare taxes while working.1 It’s important to note, however, that annually adjusted standard deductibles still apply.

Many pre-retirees are frequently warned that Medicare Part A will only cover a maximum of 100 days of nursing home care (provided certain conditions are met). Under the current Part A rules, you would pay $0 for days 1-20 of care in a skilled nursing facility (SNF). During days 21-100, a $176 daily coinsurance payment may be required of you.3  

Knowing the limitations of Part A, some people look for other choices when it comes to managing the costs of extended care.

Part B: Medical Insurance

Part B is considered the medical insurance portion of Medicare.

It covers expenses like:2

• Physicians’ fees
• Outpatient hospital care
• Certain home health services
• Durable medical equipment
• Some offerings not covered by Medicare Part A

Part B does come with some costs, however, which are adjusted annually. The premiums vary, according to the Medicare recipient’s income level, but the standard monthly premium amount for joint tax returns with income up to $174,000 (individual filers up to $87,000) was $144.60 for 2020, with a yearly deductible of $198.3   

Part C: Medicare Advantage

Sometimes called “Medicare Part C,” Medicare Advantage (MA) plans are often viewed as an all-in-one alternative to Original Medicare.

MA plans are offered by private companies approved by the federal government. Although these plans come with standardized minimum coverage, the amount of additional protection offered can differ drastically from one person to the next. This is due to unique provider networks, premiums, copays, coinsurance and out-of-pocket spending limits.

If you’re interested in obtaining a MA plan, you may find it beneficial to compare prices and services offered from different vendors.

Part D: Prescription Drug Coverage

While MA plans often offer prescription drug coverage, insurers also sell federally standardized Medicare Part D plans as a standalone product to those with Medicare Part A and/or Part B. 

Every Part D plan has its own list of covered medications. If you're interested in obtaining a Part D plan, Medicare’s website offers the formulary of approved drugs and prices, organized by tier.

If you’re approaching 65 or think you may be otherwise eligible for Medicare, review each part carefully to determine what may work best for you. If you have any questions, give us a call.  We are always happy to talk through the options that might make sense for you given your own unique situation and if needed, refer you to a specialist in this area.