The Difference Between Medicare Part A And Medicare Part B
Medicare Part B covers outpatient and preventative screenings and services. Think of it as doctor insurance. You can check your Medicare card to see if you have Part B it will be designated with the word MEDICAL. The following chart broadly illustrates what type of services each part covers.
Medicare Part A vs. Medicare Part B
|Not covered||Not covered|
Medicare Part A and Medicare Part B work in tandem. You enroll in them, or opt for Medicare Advantage plans through Part C. Advantage plans are provided by private insurance companies that approved by the Medicare program. Lastly, prescription drug coverage is provided by Medicare Part D.
Original Medicare And Medicare Advantage
Original Medicare, a government program, consists of the combination of Part A hospital insurance with Part B medical insurance. Often, it can coexist with other benefits you may have, from organizations such as Social Security or the Railroad Retirement Board
However, if you sign up for Medicare Part A only, then you do not qualify for other helpful benefits through Medicare health plans, which require having Original Medicare.
A central choice that Medicare beneficiaries make lies between getting health insurance through the government Medicare program, or through a private plan that provides equal or greater coverage than the government program.
Without both Medicare Part A and Part B, a person cannot get any benefits from Part C: Medicare Advantage plans, or the added protection of Medigap.
Medicare Advantage plans can offer more benefits than Original Medicare while possibly costing less. These Part C can even build in the prescription coverage of Part D.
Comparison shopping will help subscribers compare Original Medicare to Medicare Advantage.
Looking for Medicare coverage? Enter your zip code above for a free quote!
When Can I Enroll In Medicare Part D
To be eligible for Medicare Part D prescription drug coverage, you must have either Medicare Part A or Part B, or both. You can sign up for Medicare Part D at the same time that you enroll in Medicare Part A and B.
As mentioned above, most people who select Medicare Advantage must receive their Part D prescription benefits as part of that same Medicare Advantage plan . Medicare Savings Account plans do not include Part D coverage, nor do some Private Fee-for-Service Medicare plans. If you have an MSA or a PFFS and it doesnt have Part D coverage included, youre allowed to purchase a stand-alone Part D plan to supplement it.
As with Part B, you are still eligible for Part D prescription drug coverage if you dont enroll when youre first eligible, but you may pay higher premiums if you enroll later on, unless you had during the time that you delayed enrollment in Part D.
You May Like: Does Medicare Pay For Chair Lifts For Seniors
Who Qualifies For Premium
Most people dont have to pay a monthly premium for their Medicare Part A coverage. If youve worked for a total of 40 quarters or more during your lifetime, youve already paid for your Medicare Part A coverage through those income taxes.
Outside of qualifying for premium-free Part A based on your work history, there are a few other situations when you may receive coverage without a monthly premium:
- Youre 65 years old and receive retirement benefits from Social Security or the Railroad Retirement Board .
- Youre 65 years old and you or your spouse had Medicare-covered health benefits from a government job.
- Youre under age 65 and have received Social Security or RRB disability benefits for 24 months.
Before You Buy Medigap
Here are some things to keep in mind before you purchase your Medigap policy:
Don’t Miss: Can I Sign Up For Medicare Advantage At Any Time
Companies With Fewer Than 20 Employees
If a personâs employer has fewer than 20 employees, the Medicare rules about enrollment are different because it is up to the employer to decide if the employee should enroll in original Medicare when they are first eligible at the age of 65 years.
If a person does enroll in original Medicare, the employerâs health plan becomes the secondary payer because Medicare will settle any medical bills first. The personâs group health insurance only pays for any outstanding services, according to how Medicare works with other types of coverage.
Medicare Part C: Medicare Advantage Plans
Many people opt for Medicare Part C, also known as a Medicare Advantage plan, rather than Original Medicare.
Unlike Original Medicare, which is covered by the federal government, Medicare Advantage plans are issued by private health insurance companies. Medicare Part C plans combine the coverages of Part A and Part B, and they often cover benefits Original Medicare doesnt, including hearing, dental, or vision services. Many plans even offer prescription drug coverage as well.
In some cases, your out-of-pocket costs with a Medicare Advantage plan will be lower than they would be with Original Medicare, making them an affordable alternative. In fact, the average premium is just $21 per month in 2021, in addition to your Medicare Part B premium.
Also Check: How Much Does Medicare Pay For Home Health Care
Is There Other Medicare Hospitalization Coverage
Theres more to Medicare than Part A there are also parts B, C, and D. You or a loved one dont have to utilize any other parts. They do each have a monthly premium. Examples of services covered under each include:
- Part B.Medicare Part B covers some expenses for doctors visits, medical equipment, diagnostic screenings, and some other outpatient services that you may need.
- Part C. Medicare Part C covers the services of parts A and B. It may also cover prescription drugs, dental, and vision, depending on the plan you choose. Most of these plans work through in-network doctors or securing a referral from a primary care doctor who manages your care.
- Part D.Medicare Part D covers prescription drugs. Like Medicare parts B and C, you have to pay a premium for this coverage. There are several Part D plan types, and you buy them from a private insurer.
Of course, there are some services that original Medicare doesnt usually cover. Sometimes, a person has private insurance that may pay for these services, or they pay for them out-of-pocket. Examples include:
If you arent sure if a service is covered under different Medicare types, you can call 800-MEDICARE to ask.
If you or a loved one is in the hospital, youll usually have a case worker assigned to you who can help answer questions about Medicare coverage.
What Is The Medicare Buy
According to the Centers for Medicare & Medicaid Services , the Medicare buy-in program enables states to help more than 10 million Americans pay their monthly Medicare Part B premiums and more than 700,000 people pay their Part A premiums.
All states offer buy-in for Part B, but fewer states offer Part A buy-in. This is because the Part A premium is free for most people. The qualifications for Part A and Part B buy-in are different.
If youre eligible for Medicare, you must enroll in Part A or Part B during set enrollment periods or else pay penalties. If you qualify for the buy-in program, however, these penalties and timeframes are waived.
The Medicare buy-in program is also connected to Medicaid eligibility for prescription drug assistance through a program known as Extra Help. Well discuss this additional program a bit later.
Don’t Miss: How To Get A Medicare Number As A Provider
The Cost Of Medicare Part B
Unlike Medicare Part A, Medicare Part B requires a premium from everyone. The standard premium for Medicare Part B in 2021 is $148.50 a month, which applies to most people, including new enrollees. That premium changes each year, usually increasing. In 2022, the Part B premium jumps to $170.10 a month.
Youll also have an annual deductible of $233 in 2021 as well as a 20 percent coinsurance rate for covered services under Part B.
There are penalty fees for not signing up during your Initial Enrollment Period , but well discuss those in a separate section.
While most people pay the standard amounts for premiums and deductibles, some people will pay more, depending on their income. The more you make, the higher your likelihood will be for paying more than the standard amount. The extra fee per month is called the Income Related Monthly Adjustment Amount . How much more can you expect to pay if you fall outside of the standard range? The Medicare website offers a handy chart on the rates for those with higher incomes, which is updated each year. These are the rates for 2022, based on the income reported on your 2020 tax return:
These amounts reflect individual incomes only. Married couples will pay the same rates, but for different, higher thresholds. For example, a couple that earns over $182,000 per year and files a joint tax return will pay $238.10 per month for Medicare Part B premiums. Married couples who file separate tax returns also have different thresholds.
Medicare Part C: Medicare Advantage
Also known as Medicare Advantage, Part C is an alternative to traditional Medicare coverage. Coverage normally includes all of Parts A and B, a prescription drug plan , and, depending on your choice of a Medicare Advantage plan, other possible benefits.
Part C is administered by Medicare-approved private insurance companies that collect your Medicare payment from the federal government.
Depending on the plan, you may or may not need to pay an additional premium for Part C. You still need to pay your Medicare Part B premium. You don’t have to enroll in a Medicare Advantage plan, but for many people, these plans can be a better deal than paying separately for Parts A, B, and D. Beneficiaries will still pay separate premiums if they don’t choose to have the Part “C/D” premium taken out of their Social Security check.
Recommended Reading: When Do Medicare Benefits Start
As Soon As You Are Automatically Enrolled In Medicare
You will no longer qualify for financial help to pay for your Covered California plan after your two-year waiting period ends. You will need to cancel your health plan through Covered California at least 14 days before you want your coverage to end. If you were enrolled in Medi-Cal instead of Covered California, you can ask your local county office if you will continue to qualify for other Medi-Cal programs that can lower your Medicare costs.
Should I Get A Medicare Part C Plan
Enrollment in Medicare Part C plans has been growing, largely because Advantage plans offer more benefits than standard Medicare plans. Medicare Advantage plans usually arent the best option for low-income recipients because they can often qualify for other Medicare savings programs. Medicare Advantage also isnt generally necessary if youre still receiving employer-sponsored coverage.
Pros of Medicare Part C
Provides coverage for services Original Medicare does not, like vision or dental
Usually offers prescription drug coverage
Caps out-of-pocket expenses, unlike traditional Medicare
Cons of Medicare Part C
Likely have to pay two premiums, one for Medicare Part B and one for your Advantage Plan
Many types of individual plans, each with their own rules on the coverage and costs for using out-of-network providers
Your network of available health care providers is smaller than with Original Medicare plans
Not all in-network providers are necessarily accepting new patients
Cant be used in conjunction with employer-sponsored health care benefits that supplement Original Medicare
Senior Editor & Personal Finance Expert
Derek is a former senior editor and personal finance expert at Policygenius, where he specialized in financial data, taxes, estate planning, and investing. Previously, he was a staff writer at SmartAsset.
Questions about this page? Email us at .
32 Old Slip, 30th Fl New York, NY 10005
Recommended Reading: What Does Medicare Part C Cost
Can I Decline Medicare Altogether
Medicare isnt exactly mandatory, but it can be complicated to decline. Late enrollment comes with penalties, and some parts of the program are optional to add, like Medicare parts C and D. Medicare parts A and B are the foundation of Medicare, though, and to decline these comes with consequences.
The Social Security Administration oversees the Medicare program and recommends signing up for Medicare when you are initially eligible, even if you dont plan to retire or use your benefits right away. The exception is when you are still participating in an employer-based health plan, in which case you can sign up for Medicare late, usually without penalty.
While you can decline Medicare altogether, Part A at the very least is premium-free for most people, and wont cost you anything if you elect not to use it. Declining your Medicare Part A and Part B benefits completely is possible, but you are required to withdraw from all of your monthly benefits to do so. This means you can no longer receive Social Security or RRB benefits and must repay anything you have already received when you withdraw from the program.
How Do Medicare Part C Plans Work
Medicare Advantage plans all offer you care through a network of health care providers. Plans are divided into multiple types based on whether you can use providers outside of your network and how much you would have to pay for doing so. This is the same system that other private insurance plans use. Plans may not advertise very clearly what type they are, so make sure to check the plan details for more information.
The table below lays out the major features for each type of Medicare Advantage, and then we go into more detail on each one.
Read Also: Does Medicare Cover When Out Of Country
Medicare Faqs And Information To Consider
If you are already receiving Social Security benefits, Railroad Retirement benefits, or Federal Retiree benefits, your enrollment in Medicare is automatic. Your Medicare card should arrive in the mail shortly before your 65th birthday. Check the card when you receive it to verify that you are entitled to both Medicare Parts A and B.
Initial Enrollment Period:
If you are not eligible for Automatic Enrollment, contact the Social Security Administration at 800-772-1213 or enroll online at www.socialsecurity.gov, or visit the nearest Social Security office to enroll in Medicare Part A and Medicare Part B. You have a seven month window in which to enroll in Medicare without incurring a penalty. If youre not automatically enrolled in premium-free Part A, you can sign up for it once your Initial Enrollment Period starts. Your Part A coverage will start six months back from the date you apply for Medicare, but no earlier than the first month you were eligible for Medicare. However, you can only sign up for Part B during the times listed below.
General Enrollment Period:
- General Enrollment Period for Medicare Parts A & B
If you have coverage through a current employer, you are not required to enroll in Medicare Part A and B. Below are some things to keep in mind about each part of Medicare.
What If Ive Worked But Not Long Enough
You can still get Medicare Part A coverage, even if you dont fully meet the work requirement of 40 credits. Heres what youll pay in 2022:
- If you have 30 to 39 credits, your Part A premium will cost $274 per month.
- If you have fewer than 30 credits, your Part A premium will cost $499 per month.
- If youre able to continue working and you accumulate 40 work credits, you wont have to pay the monthly premium for Part A coverage.
Part A is the only part of Medicare that requires a specific amount of work history. You can enroll in Medicare parts B, C, and D without a work history.
You May Like: How Much Is Part B Deductible For Medicare
Medicare Isnt Just One Insurance Plan
Medicare is a lot more complicated than you may realize. Many Americans know that it has two parts Part A and Part B that cover most garden-variety health services and major operations. However, there are also other parts that cover a plethora of additional services. Understanding each part of Medicare can help you make smart healthcare decisions during retirement.
Lets go over the various parts of Medicare and the benefits they provide.
What Are The Different Types Of Medicare
There are four types of Medicare: A, B, C, and D. Part A covers payments for treatment in a medical facility. Part B covers medical services including doctor’s visits, medical equipment, outpatient care, outpatient procedures, purchase of blood, mammograms, cardiac rehabilitation, and cancer treatments. Part C, also known as Medicare Advantage, seeks to cover any coverage gaps. Part D covers prescription drug benefits.
Don’t Miss: Can You Get Medicare Advantage Without Part B