Medicare is health insurance from the federal government for people 65 and older, and for some younger people with certain health conditions. It can feel like alphabet soup at first. It gets much easier once you know what each letter means.
The four parts of Medicare
Part A: hospital care
Part A helps pay for a stay in the hospital, care in a skilled nursing facility after a hospital stay, hospice, and some home health care. Most people do not pay a monthly premium for Part A because they or a spouse paid Medicare taxes while working. You still pay a deductible and some costs if you are in the hospital.
Part B: doctors and outpatient care
Part B helps pay for doctor visits, lab tests, X-rays, outpatient surgery, some preventive care, and medical equipment like walkers. Part B has a monthly premium and a yearly deductible. After that, you usually pay 20% of the Medicare-approved amount, and there is no yearly cap on that 20% in Original Medicare.
Parts A and B together are called Original Medicare.
Part C: Medicare Advantage
Part C plans are offered by private insurance companies that contract with Medicare. They cover everything Parts A and B cover, and most also include drug coverage. Many add extras like some dental, vision or hearing. Most use a network of doctors and hospitals, and some services need approval from the plan first. That approval is called prior authorization.
Part D: prescription drugs
Part D helps pay for medicines. You get it through a separate drug plan (if you have Original Medicare) or inside most Advantage plans. Each plan has its own list of covered drugs, called a formulary, and its own pharmacy network. There is now a yearly cap on what you pay out of pocket for covered drugs. See Medicare costs for this year's amount.
What Original Medicare does not cover
This surprises a lot of people. Original Medicare does not pay for:
- Routine dental care, like cleanings, fillings, extractions and dentures
- Most vision care, like routine eye exams and glasses
- Most hearing care, like routine hearing exams and hearing aids
- Long-term custodial care, which means help with daily tasks like bathing and dressing, in a nursing home or at home
Some Advantage plans include some dental, vision and hearing. You can also buy a separate dental plan. See dental, vision and hearing for your choices.
Medicare Supplement or Medicare Advantage?
Once you have Parts A and B, most people choose one of two paths to fill the gaps. Neither is right for everyone. Here is how they compare in general. Details vary by plan.
| Medicare Supplement (Medigap) | Medicare Advantage (Part C) | |
|---|---|---|
| Doctors and hospitals | Any provider in the U.S. that takes Medicare | Usually a network; going outside it may cost more or not be covered |
| Monthly premium | Yes, plus your Part B premium | Varies; some plans have no extra premium, but you still pay Part B |
| Costs when you get care | Low or none, depending on the plan letter | Copays and coinsurance, up to a yearly out-of-pocket limit |
| Prior authorization | Generally not required by the Supplement | Often required for some services |
| Drug coverage | Not included; add a Part D plan | Usually included |
| Dental, vision, hearing | Not included | Often some included |
| Switching later | Health questions may apply after your Medigap open enrollment period | Can change each fall during Annual Enrollment |
The biggest question for many people in Kansas City is simple: will my doctor and my hospital be covered? Networks change every year. We check for you before you pick.
Medicare before 65
Some people get Medicare before they turn 65:
- Disability: after you have received Social Security Disability Insurance (SSDI) checks for 24 months, Medicare usually starts on its own in month 25.
- ALS (Lou Gehrig's disease): Medicare starts the same month your disability benefits begin, with no 24-month wait.
- End-stage renal disease (ESRD): permanent kidney failure that needs dialysis or a transplant can qualify you, if you meet the work history rules.
Supplement rules for people under 65 are different from state to state. Call us and we will walk through what applies to you.
Call us first
You do not have to sort this out alone. We are a local, independent agency. We compare plans from many insurance companies, it is free to work with us, and we stay with you every year after. Book a free review or call (816) 307-6165.
Questions people ask us
Is Medicare free?
Most people pay no monthly premium for Part A. Part B, Part D and most extra plans have a monthly premium. See this year's amounts on our Medicare costs page.
Can I switch from Advantage to a Supplement later?
Sometimes, but it can be hard. Outside your Medigap open enrollment period and a few special cases, Supplement companies can ask health questions and say no. Call us before you switch.
Does Medicare cover dental?
Original Medicare does not cover routine dental care like cleanings, fillings or dentures. Some Advantage plans include dental, and you can also buy a separate dental plan. See dental, vision and hearing.
What is the difference between Medicare and Medicaid?
Medicare is federal health insurance for people 65 and older and some younger people with disabilities. Medicaid is run by each state for people with limited income and savings. Some people qualify for both.