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Homepage > Medicare Insurance For Dummies: Everything You Need To Know


Medicare Insurance For Dummies - Everything You Need To Know: Introduction

Compared to many other first-world nations, America's health care system is lacking, to say the least. Historically, most health insurance plans in the United States have been controlled by the private sector. If you wanted insurance, you paid a monthly premium and in return, the insurance company would help you pay for treatment, hospital bills, and a prescription drug if it was needed.

However, this model of privatized health care had one large flaw- it left out the elderly. People over age 65 are often the ones who need the best health plan. Typically, individuals over age 65 or older need more prescription drugs, more doctor's visits, and more overall care.

While social security provided a small safety net for those age 65 and older, this meager monthly payment often wasn't enough to pay for expensive health plan premiums. So, in 1965, former President Lyndon B. Johnson started Medicare- a health insurance plan funded by the U.S. government.

Medicare is designed for U.S. citizens age 65 or older. It works a lot like a standard health insurance company, but the monthly premium costs are significantly more affordable. There are several different types of Medicare coverage plans, designed to cater to the needs of various people.

In this article, we'll be giving you a full breakdown of Medicare coverage; what the difference between Medicare part A, B, C, and D are, how it works with your existing health plan, how to enroll in Medicare, as well as the various Medicare benefits that people can take advantage of. So sit back and enjoy!

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Medicare Insurance Coverage: What is Medicare Insurance?

If you're just looking into Medicare for the first time, it can often be confusing. The federal government hasn't necessarily done the best job as far as providing resources and information about various Medicare coverage plans, how they affect your social security, and other issues and questions.

If you've been struggling to understand the ABCs of Medicare, we're here to help you break through the confusion so that you can make sure that you can enroll in to the best Medicare plan for you!


What's The Difference Between Medicare And Medicaid?

Many people still don't know the difference between Medicare and Medicaid. They both sound the same, so what's the difference?

Both are federal health insurance plans designed to give affordable or no-cost health insurance to qualifying individuals who are unable to pay a premium for private insurance plans. The main difference is that traditionally Medicare covers benefits for those over 65, while Medicaid is a free or low-cost insurance plan designed to provide basic coverage and benefits for low-income people.


Medicare Eligibility

Although the Medicare program primarily provides coverage for seniors, there are a few other extenuating situations that would allow somebody younger to be eligible for Medicare services. These include:

  • Younger individuals who have disabilities or a serious health condition.

  • Those who have already been given their social security benefits.

  • Individuals who benefit from the Railroad Retirement Board's disability program.

  • Patients who are on kidney dialysis or who need a kidney transplant.

Keep in mind that by the time most people reach their 50s and 60s, they've been paying into Medicare for their entire life out of each paycheck and their annual taxes. The Medicare health insurance plan is closely tied to your social security benefits and is a program that every American worker and business owner pays taxes into for the benefit of society.


What Does Medicare Cover?

Medicare has 5 main healthcare plans for seniors that are 65 or older as well as people with disabilities and several chronic health conditions, in a nutshell:

  • Medicare Part A covers basic hospitalization.
  • Medicare part B provides coverage for doctor visits, diagnostic tests and their likes.
  • Medicare Part C (also called Medicare Advantage) combines both Medicare Part A and Medicare Part B coverage with additional benefits.
  • Medicare Part D covers prescription drugs.
  • Medicare supplement plans such as Medigap are private coverages and it covers out-of-pocket expenses such as co-pays, co-insurance, and deductibles.

Original Medicare vs Medicare Advantage

When Medicare was first created, there were two parts- Medicare part A and Medicare part B. Medicare part A covered hospital visits, ambulances, and emergency care, whereas Medicare part B primarily covered specialist care and covered a broader scope of conditions.


Many people are still on this plan and it is referred to as Original Medicare since the health coverage plans haven't changed much since the program started. The only addition to Original Medicare plans is that they now include Medicare part D, which helps to pay for prescription drug costs.


What is Medicare Advantage

In 1997, former President Bill Clinton signed the Medicare + Choice Act, which was eventually renamed Medicare Advantage (or Medicare part C). Essentially this provided the same benefits as Medicare part B and Medicare part A, but allowed beneficiaries to enroll through private insurance plans if they wished to receive better coverage.


Can I Drop or Change My Medicare Advantage Plan?

Should you ever wish to drop your MA plan or enroll in a different plan, then you just need to apply for your new plan during the Medicare open enrollment period from January 1 to March 31. As long as you meet the deadline, your old policy should automatically switch to the new policy when your last one ends. If you wish to switch from an MA plan to Original Medicare, then you'll need to apply through the social security website or give them a call to discuss options.



What's The Difference Between Medicare Part A, B, C and D? 

Here's a full breakdown of the differences in coverage between the 4 parts so you can better understand each.


Medicare Part A: Hospital Insurance

Medicare part A is the most basic form of U.S. government insurance. It's designed to mainly cover emergency costs such as hospitals, emergency room treatment, and ambulance rides. Additionally, it also covers short-term stays in nursing facilities as well as a bit of in-home medical treatment for those with eligible disabilities.


Medicare Part B: Medical Insurance

While part A is designed to pay for medical emergencies and essential care, not all conditions require emergency care. Medicare Part B covers all of the things that part A doesn't. For example, if you need outpatient care or physical therapy after your emergency surgery, then this would be covered by part B.

Part B insurance will help pay for the costs of certain specialist doctors (e.g., spine doctor, E.N.T. doctor, gynecologist, etc.) that still provide vital services. Medicare Part B will also help you pay the cost of high-quality medical equipment such as wheelchairs, canes, walkers, or even hospital beds.


Medicare Part C: Medicare Advantage Plans

The Medicare Advantage plan has all of the benefits of part A and part B, with one big difference- it allows individuals to receive Medicare benefits through enrollment in a private health insurance plan. Medicare

Typically referred to as Medicare part C or an MA plan, these plans work almost exactly the same as a typical private health insurance plan. They are often given to individuals who have worked with a long-standing company that pays for their insurance.

Those who need specialty medical treatment may also enroll in an MA plan so that they can get access to a larger network of doctors than those provided by typical treatment centers for Medicare. Ultimately Medicare Advantage was created to give patients more choices and connect them with the specialists they need.


Medicare Part D: Prescription Drug Coverage

Medicare part D is also covered under the Original Medicare plans, along with part A and part B. If you've ever had to pay full price for prescription drugs at your local pharmacy, then you know just how expensive they can be. In some cases, life-saving medication would cost thousands of dollars per month without coverage.

Part D provides prescription drug coverage to individuals who have been prescribed necessary medicine by their primary care doctors. Although it doesn't cover a huge amount, it will typically cover between 20 and 30% of the total costs.

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How Much Does Medicare Cost Per Month/Year?

As mentioned earlier, in order to enroll into Medicare plans, you either have to be at least 65-years-old, have a severe disability, or be eligible for other government plans. Technically, Original Medicare (part A and B) costs are the same in every state and has no premiums for eligible individuals - or offers low-cost premiums. 

However, keep in mind that every U.S. citizen pays into Medicare with each check they get. If you ever look at your pay stub, you'll be able to see exactly how much was taken out of each check to go towards the government service.

So, even though it's "free," the reality is that you already spent your whole life paying for it. So, the point is- take full advantage of your medical coverage and the retirement benefit.


How Much Does Medicare Part A Cost?

Medicare Part A, that covers hospital care, is free in 99% of the cases.


How Much Does Medicare Part B Cost?

In 2021, you can expect to pay $148.5 per month for standard Medicare part B premiums, which is an increase from 2020's $145.60. The part B deductible in 2021 is $203, which is up from $198 in 2020.


How Much Does Medicare Part C Cost Per Month/Year? (Medicare Advantage Plan Cost)

Please find the average Medicare part C premium per month and per year in different states in the U.S:

State Average Medicare Part C Cost Per MonthAverage Medicare Part C Cost Per YearAverage Drug Deductible
Alabama$25$300$140
Arizona$12$144$138
Arkansas$22$260$210
California$21$252$140
Colorado$22$260$100
Connecticut$39$348$177
Delaware$23$276$66
Florida
$8
$96$99
Georgia$19$228$178
Hawaii $36
$432$202
Idaho$32$384$134
Illinois$26$312$108
Indiana$18$216$102
Iowa$28$336$68
Kansas$17$204$92
Kentucky$18$216$95
Louisiana$26$312$162
Maine$23$276$173
Maryland$55$660$89
Massachusetts$61$732$221
Michigan$51$612$62
Minnesota$62$744$288
Mississippi$17$204$286
Missouri$10$120$98
Montana$42$504$350
Nebraska$13$156$116
Nevada$12$144$129
New Hampshire$31$372$232
New Jersey$25$300$199
New Mexico$28$336$233
New York$33$396$234
North Carolina$18$216$142
North Dakota$64$768$336
Ohio $21$252$98
Oklahoma$15$180$108
Oregon$44$528$148
Pennsylvania$44$528$34
Rhode Island$25$300$58
South Carolina$13$156$147
South Dakota$42$504$296
Tennessee$21$252$118
Texas$11$132$164
Utah$19$228$157
Vermont$26$312$142
Virginia$20$140$164
Washington$39$468$138
West Virginia$32$384$110
Wisconsin$34$408$218
Wyoming$57$684$277
- Medicare Advantage plans are not sold in Alaska


How Much Does Medicare Part D Cost?

Please find Medicare part D cost comparison in 2021 below.

StateMedicare Part D Cost Per MonthMedicare Part D Cost Per YearAverage Deductible
Alabama$39$468$332
Alaska$33$396$362
Arizona$37$444$322
Arkansas$36$432$322
California$41$492$328
Colorado$39$468$331
Connecticut$38$456$326
Delaware$32$384$349
Florida
$42
$504$339
Georgia$34$408$334
Hawaii$34
$408$356
Idaho$40$480$333
Illinois$37$444$334
Indiana$31$372$335
Iowa$38$456$337
Kansas$33$396$332
Kentucky$31$372$339
Louisiana$35$420$340
Maine$34$408$338
Maryland$32$384$358
Massachusetts$38$456$332
Michigan$34$408$338
Minnesota$38$456$337
Mississippi$31$372$349
Missouri$35$420$324
Montana$38$456$338
Nebraska$38$456$338
Nevada$33$396$343
New Hampshire$34$408$338
New Jersey$40$480$335
New Mexico$39$468$339
New York$40$480$325
North Carolina$36$432$338
North Dakota$38$456$339
Ohio$33$396$348
Oklahoma$35$420$360
Oregon$38$456$340
Pennsylvania$42$504$324
Rhode Island$38$456$336
South Carolina$42$504$338
South Dakota$38$456$342
Tennessee$39$468$342
Texas$38$456$341
Utah$40$480$333
Vermont$38$456$334
Virginia$32$384$346
Washington$38$456$343
West Virginia$42$504$325
Wisconsin$39$468$320
Wyoming$38$456$344


Do I Need Health Insurance With Medicare?

No, there is no reason why you would need to keep your existing health care plan, especially if you're 65 or older and are already eligible to enroll in Medicare. Medicare plans typically offer the same amount of health coverage as private a private health plan for a fraction of the cost.

The main disadvantage of enrollment in Medicare is that you'll have to start going to in-network centers for Medicare/Medicaid. If you've been used to going through the same network of doctors through your existing health care plan, then you may have to give some of them up. 

This may be especially difficult for those who, at age 65, have already built long-standing relationships with their doctors.

Should you still wish to have access to a broader network of specialists and outpatient services, then enrollment in a Medicare Advantage plan may be the best choice. The experience will be almost identical to what you're used to with a standard health insurance company, but the costs should be lower.


What is The Best Medicare Coverage Plan?

There are currently four different parts to Medicare- A, B, C, and D. The premium for part A and B is usually free as long as you're at least age 65 or have a severe disability. If you want more choices when it comes to your medical treatment facilities and doctors, though, you may appreciate paying the higher premium to enroll in part C plans.

Ultimately, it all comes down to how much coverage you want your insurance health plan to cover. With an Advantage Medicare plan, you'll typically be able to choose between the following types of insurance plans:

  • Special Needs Plans

  • Private Fee-for-Service  Plans

  • Preferred Provider Organization  Plans

  • Health Maintenance Organization  Plans

Within each of these plans, you'll also be able to choose between several "tiers" of options. Lower-level tiers offer lower premiums and higher deductibles, whereas high-level (more expensive) tiers give you more treatment options and lower deductibles.


Does Medicare Part B Include Dental Insurance?

One of the most commonly asked questions by first-time beneficiaries is whether or not dental insurance is included. The older one gets, the more dental treatment they require, so it helps to have access to inexpensive options.

Unfortunately, neither part A or part B covers dental services. This means that if you want to get your teeth fixed under Original Medicare, then you'll have to pay out-of-pocket or choose a third-party dental insurer.

A third option would be to apply for an Advantage care plan through a private insurer that bundles dental insurance into their plans. Although you would have to pay a higher monthly premium, it would be considerably lower than going solely through a third-party insurance company.

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Medicare Enrollment: How Do I Sign Up For Medicare Part A, B, C and D?

Although the specifics of Medicare itself may be hard to understand, Medicare enrollment and signing up for Medicare are fairly straightforward. All you need to do is either find the closest social security administration office or compare medicare insurance plans and apply for medicare online through the many options accessible through this website.


Apply Through The Social Security Administration

Typically, you would apply for Medicare medical coverage through your local SSA office. However, COVID-19 has permanently closed some of these facilities, so you may need to apply for Medicare through the administration's website instead. At least you don't have to wait in line anymore!

In order to complete enrollment in the program, they'll usually need a history of your medical records as well as information on where you live, your age, employment status, and other basic information.


Discuss Your Plan

Once your information has been verified, they will give you some resources and talk to you about the different medical coverage plans to help you find the best one. Once approved, they should issue you a Medicare I.D. card through the mail. They'll also issue you a temporary paper copy of the card that you can use as proof of enrollment in the meantime.

 

 

Sources and References

  1. https://www.cms.gov/About-CMS/Agency-Information/History

  2. https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance#:~:text=If%20you%20buy%20Part%20A,Part%20A%20premium%20is%20%24259

  3. https://www.ssa.gov/benefits/medicare/mediinfo.html

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