Medicare has multiple parts, coverage, rules and choices. What Medicare covers and what it doesn’t can be confusing. 

Life & Health Agent, Colleen Corrigan, spoke with Insure.com to discuss Medicare Parts A, B, C, and D, and how you can make a more informed decision about your options. 

What does Medicare Part A cover and not cover? 

Part A covers inpatient hospital, hospice and home health care. And it helps pay a stay in a skilled nursing facility like a nursing home, but only for up to 100 days.

As long as someone or their spouse has worked and paid taxes for 40 quarters, or 10 years, they will receive Medicare Part A at no charge.

“Otherwise, you could pay a premium as high as $458 a month,” said Colleen. 

What does Medicare Part B cover and not cover? 

Part B will pay for doctor visits, lab tests, diagnostic screening, mental health, outpatient care at hospitals and clinics, emergency care, durable medical equipment and associated expenses. But first, you have to pay a $198 annual deductible.

"After the deductible is met, you typically pay 20% of the Medicare-approved amount," Colleen commented.

Part B also carries a monthly premium.

What does Medicare Part C (Medicare Advantage) cover and not cover?

Medicare Advantage plans are typically structured as either a health maintenance organization (HMO) or preferred provider organization (PPO) plan. Medicare Advantage plans have a maximum out-of-pocket cost of $6,700 for in-network services, but this amount doesn’t include prescription drug costs. Most Medicare Advantage plans include prescription drug coverage.

What does Medicare Part D cover and not cover?

Part D, a prescription drug plan, is available separately if you're enrolled in Parts A and/or B. Part D plans are provided via private companies.

Your deductible can range from $0 to $435; once that amount is reached, you pay a copay or coinsurance for each medication. If what you've paid out of pocket for drugs plus what your Part D plan has paid totals $4,020, your out-of-pocket amount equates to 25% of the prescription cost. This period is called the coverage gap "donut hole," when brand-name prescriptions can get pricey.

Part D doesn’t cover:

• Over-the-counter drugs

• Drugs sold outside of the United States

• Drugs not approved by the Food and Drug Administration

• Drugs not used for a medically accepted reason

Medigap plans can help Original Medicare beneficiaries 

If you have Original Medicare, you may want to look into a Medigap plan to help pay for your care.

"Medigap fills in the gaps that Original Medicare does not pay for," said Colleen. "For instance, when you visit the doctor, Parts A and B will only pay for its part of the covered costs. But a Medigap plan will pick up at least some of the remaining medical cost."

Read the full article at Insure.com.

Questions about Medicare or other health insurance coverage? Contact Wallace & Turner at (937) 324-8492 in Springfield, (937) 652-8492 in Urbana, or info@wtins.com.