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Medicare Explained

At Peritia Advisors, our mission is to provide you with insurance that keeps you healthy and happy, no matter what your situation. Get in touch with us with any Medicare questions you may have.

Original Medicare includes hospital and medical insurance, which covers inpatient, preventive, and medically necessary care. Medicare Advantage plans cover this and offer additional benefits such as prescription drug coverage and packages for hearing, dental, or vision care. Separate Part D prescription drug plans bring you set copayments for prescriptions in return for monthly premiums. Medicare Supplements help pay for the out-of-pocket costs to Medicare.

Medicare Part A

Part A is Medicare’s hospital insurance. It covers inpatient care in a hospital or skilled nursing facility, as well as hospice care and home health care.

The costs of Medicare Part A include the monthly premiums, deductibles, and coinsurance. Many people receive Part A without having to pay premiums. Premiums are $259 in 2021 for people with 30-39 work credits and $471 in 2021 for people with fewer than 30 work credits. 

The Part A deductible is $1,484 for each benefit period, which is the stretch of time between admittance in a hospital or skilled nursing facility and once you have not received inpatient care for 60 days. Coinsurance begins after 60 days in a hospital or mental health inpatient facility or after 20 days in a skilled nursing facility.

Medicare Part B

Part B is Medicare’s medical insurance. It covers preventive and medically necessary care, which can include coverage for clinical research, ambulance services, durable medical equipment (DME), mental health care, and limited outpatient prescription drugs.

Everyone pays a premium for Part B, which is usually taken out of your Social Security check or billed every three months. The Part B premium in 2021 is $148.50. If you make more than $88,000 as an individual or $176,000 as a married couple, you will owe an Income Related Monthly Adjustment Amount (IRMAA) to Medicare, which raises your premiums. 

The Part B deductible is $203 in 2021. After you reach this amount in out-of-pocket spending, you will pay 20% of the Medicare-approved amount for healthcare services as a copayment.

Medicare Advantage

Medicare Advantage plans, also known as Part C, are plans from private insurance companies approved by Medicare to provide your Part A and Part B coverage. These plans bring you the same basic coverage as Original Medicare (A and B). Many plans also offer prescription drug coverage and additional packages for dental, vision, or hearing care. You may find some with a health club or gym membership benefits as well.

These plans generally operate with networks of healthcare providers, and seeing providers within the plan’s network will save you money. Available Medicare Advantage plan types include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Medicare Medical Savings Account (MSA) plans, and Special Needs Plans (SNPs).

Costs under Medicare Advantage plans vary. You can expect to pay premiums (which may be as low as $0 per month) as well as copayments, deductibles, and coinsurance

Medicare Part D Prescription Drug Plans

Part D plans are standalone supplements held in addition to Original Medicare by those who need coverage for prescriptions. Each plan covers nearly all anticancer, anticonvulsants, antidepressants, antipsychotics, antiretrovirals, and immunosuppressants. Coverage for specific medications will vary between plan options.

The costs for Part D plans include monthly premiums paid to your plan and any additional charges (IRMAA) owed to Medicare due to your high income. You will pay copayments for your prescriptions at the pharmacy based on whether your drug is preferred or non-preferred, generic, brand-name, or specialty. Deductibles will also vary by plan.

Medicare Supplements

Medicare Supplement plans, sometimes called Medigap, are designed to help you pay for the out-of-pocket costs of your healthcare. Coverage can include help paying your Part A and B coinsurance, copayments, and deductibles. There are 10 available plans, lettered A, B, C, D, F, G, K, L, M, and N.

Contact Us

For more information about the ins and outs of Medicare, contact Peritia Advisors today.