As you approach the age of 65, the terms Medicare, Parts A-D coverage, Centers for Medicare and Medicaid Services and others become more prominent and overwhelming. As of 2021, more than 61 million Americans rely on Medicare to help defray the high cost of healthcare. And while almost every American ages 65 and older is entitled to get it, you are not obliged to. So what is Medicare? How can you leverage what is offered in each part to keep you healthy? Let’s start from the beginning.
Founded in 1965 under the Social Security Administration, Medicare is the system that provides federal health insurance to Americans ages 65 and older (with some exceptions for younger folks). While Medicare is a federal program, it’s funded by taxpayers. (If you’ve ever wondered what “FICA” means on your paycheck stub, that’s you paying Medicare forward.)
Medicare consists of four parts:
- Medicare Part A (Hospital insurance)
-
- Known as hospital insurance, Medicare Part A covers inpatient hospital stays, skilled nursing facility care and hospice care.
- If you paid Medicare taxes while working, Part A coverage comes with a free premium. If you don’t qualify for free coverage, the maximum premium for Part A coverage in 2021 is $471.
- In 2022, Medicare will charge a deductible of $1,556 if you are hospitalized, and will typically cover most hospital services for the first 60 days after you’re admitted.
- Medicare Part B (Medical insurance)
-
- Medicare Part B covers many things including medical supplies, preventive services and professionally-administered prescription drugs. It also includes doctors’ services in an outpatient setting (and inpatient, in some cases), but not actual facility fees. (For example, Medicare Part B will cover the cost of a Tryon gastroenterologist, but Medicare Part A will cover the cost of the Tryon Endoscopy Center.)
- Enrollees in Part B typically pay a premium for coverage. In 2022, the standard premium will be $170.10, though this amount could be higher based on your income.
- The deductible for Part B services will be $233 for 2022, and beneficiaries will be responsible for 20% of the cost for doctor visits and other outpatient services.
- Medicare Part C (Managed Medicare or Medicare Advantage)
-
- By now you have probably seen many commercials on TV or recycled many postcards for Medicare Part C, which are private health plans that provide Part A and B coverage, including annual out-of-pocket expense limits. Managed Medicare and Medicare Advantage programs typically also include Part D coverage, and often provide more covered services overall that Medicare Parts A and B lack (for example, vision and dental services). You must enroll in Parts A and B to be eligible for Part C.
- Beneficiaries typically choose between enrolling in Medicare Advantage health maintenance organizations (HMOs) or preferred provider organizations (PPOs). In the former, you pick your primary care doctor, who then acts as a point person for your care and referrals to specialists. In a PPO, there is a network of providers that you can see, without needing a referral in order to see them.
- Please keep in mind not all Tryon clinicians are on every Medicare Advantage plan! Familiarize yourself with the insurance Tryon accepts.
- Medicare Part D (Prescription drug coverage)
- Medicare Part D covers most self-administered prescription drug costs, including many vaccines. See Medicare myth and facts for in-depth explanations of Medicare Part D.
Why does Tryon care about my Medicare?
Tryon is an Accountable Care Organization (ACO). According to the Centers for Medicare & Medicaid Services, “ACOs are groups of doctors, hospitals and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients.” At Tryon, we agree that coordinated care helps you get the right care at the right time, and we believe a strong patient-doctor relationship is key to that care.
Our goal is to help you navigate the healthcare system to achieve your optimal health; it is never to make unnecessary referrals that result in disjointed care or duplicative tests.
We encourage you to learn as much as you can about how Medicare can keep you healthy, starting with your Annual Wellness Visit!
Sources:
Medicare.gov Basics
AARP: Understanding Medicare