Medicare Solutions

Part A — Hospital Coverage

When you apply for Medicare, you will automatically be enrolled in Part A. It covers hospital stays, hospice care and some skilled nursing care that you may need after being hospitalized for a stroke, a broken hip or other episodes that require rehabilitation in a nursing home or other facility so you can get back on your feet.

Most people don’t have to pay a premium for Part A. You’ve already paid into the system in the form of the Medicare tax deductions on your paycheck.

However, Part A isn’t totally free.

Medicare charges a hefty deductible each time you are admitted into the hospital. It changes every year, but for 2020 it’s $1,408. You can buy a supplemental or Medigap to cover that deductible and some out-of-pocket costs for the other parts of Medicare.

Medicare pays for virtually all hospital services for the first 60 days you’re in the hospital. There are some exceptions — it won’t pay for a private room, for example.

If you are a U.S. citizen or permanent resident and have not worked long enough to qualify for Medicare, you may able to buy into the program by paying a Part A premium.

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Part B — Doctors and outpatient services

This part of Medicare covers doctor visits, lab tests, diagnostic screenings, medical equipment, ambulance transportation and other outpatient services.

Unlike Part A, Part B involves more costs, and you may want to defer signing up for Part B if you are still working and have insurance through your job or are covered by your spouse’s health plan. But if you don’t have other insurance and don’t sign up for Part B when you first enroll in Medicare, you’ll likely have to pay a higher monthly premium for as long as you’re in the program.

The federal government sets the Part B monthly premium, which is $144.60

For 2020. It may be higher if your income is more than $85,000.

You’ll also be subject to an annual deductible, set at $185 for this year. And you’ll have to pay 20 percent of the bills for doctor visits and other outpatient services. If you are collecting Social Security, the monthly premium will be deducted from your monthly benefit.

Part C — Medicare Advantage

If original Medicare is a buffet, Part C is more like a sit-down meal since a private insurer bundles together parts A and B and most likely D into one comprehensive plan.

If you decide on a Medicare Advantage— or MA — plan, you’ll still have to enroll in parts A and B and pay the Part B premium. Then, in addition, you will have to choose a Medicare Advantage plan and sign with a private insurer.

The federal government requires these plans to cover everything that original Medicare covers, and some plans pay for services that original Medicare does not, including dental and vision care. In addition, in recent years, the Centers for Medicare and Medicaid Services, which sets the rules for Medicare, has allowed Medicare Advantage plans to cover such extras as wheelchair ramps and shower grips for your home, meal delivery and transportation to and from doctors’ offices.

Most Medicare Advantage plans also fold in prescription drug coverage. Not all of these plans cover the same extra benefits, so make sure to read the plan descriptions carefully.

Medicare Advantage plans generally are either health maintenance organizations (HMOs) or preferred provider organizations (PPOs).

In HMOs you typically choose a primary care doctor who will then direct your care and usually will have to give you a referral to see a specialist. PPOs have networks of doctors that you can see and facilities you can use, often without the need of a referral.

If you go to a provider who is not in the plan’s network, you likely will pay more.

Part D — Prescription drugs

This is the part of Medicare that pays for some of your prescription drugs. You buy a Part D plan through a private insurer, like Part C.

Each generally has some premiums and other out-of-pocket costs, either flat copays for each medication or a percentage of the prescription costs. They also may have an annual deductible.

If you have really high prescription drug bills, you may be subject to the Medicare coverage gap, commonly known as the doughnut hole. Once you and your drug plan have incurred a certain amount of expense for your drugs, you’ll have to pay no more than 25 percent of the cost of brand-name prescription drugs and 37 percent of the price of generic drugs.

For 2019, that amount is $3,820. In 2020, the doughnut hole will be no more, and you’ll pay no more than 25 percent of the cost of both brand-name and generic prescriptions.

Be sure to check Medicare.gov whether the plan you’re considering has the medicines you take on their covered lists — called formularies. Those lists change from year to year, so it’s important to recheck your plan every year at open enrollment time — for 2019 from Oct. 15 to Dec. 7, 2019.