Turning 65? The ABC and D of Medicare

by Tara O'Neill, Health Plans of NC Independent Agent

Over 65

If you’re turning 65, you’ve been inundated with correspondence from insurance companies offering supplements and prescription drug plans.  Here is why.  Original Medicare only covers about 80% of many healthcare services.

Original Medicare includes Part A and Part B.

Part A is hospital insurance that helps cover inpatient hospital care, skilled nursing facility care, hospice and home health care.  If you or your spouse has paid 40 quarters into the Social Security Program, then Part A has no monthly premium.

Part B is medical insurance that helps cover medically necessary doctor services and outpatient care.  It also includes some preventive services to help you maintain good health.  There is a premium for Part B.  The premium is based on your household income.  In 2020, the base premium is $144.60 per month.  This premium may be waived if you are eligible for assistance like Medicaid.

Happy Couple  Part C is a Medicare Advantage health plan, such as an HMO or PPO, which replaces Original Medicare.  These plans are offered by private insurance companies that are approved by Medicare.  You are still responsible for the Medicare Part B premium.  Most plans also include the Part D prescription drug benefit.  Premium amounts vary by carrier.

Part D is prescription drug coverage that helps cover the cost of prescription drugs.  These plans are offered by private insurance companies that are approved by Medicare.  With Part D, the government pays a portion of certain prescriptions.  If you don’t enroll in a Part D plan during your initial enrollment period or don’t have creditable coverage like through an employer or through the VA, you will have to pay a premium penalty when you enroll in the future.  Premiums vary based on your prescription drug needs.  You may also pay more based on your income.

Medicare supplement insurance also known as a Medigap policy helps cover expenses such as copayments, coinsurance and deductibles that Original Medicare does not cover.  It does not include Part D Medicare prescription coverage so a Part D plan must be purchased separately.  Medicare supplement plans are standardized plans and are regulated by federal and state law.  For example, a Plan G offered by any insurance company provides the same standardized benefit.  The difference is premium cost, customer service, and attractive extras like exercise programs and hearing aid discounts.

Bottom line… in order to fill in the gaps of Original Medicare, you will need a supplement along with a Part D Prescription Drug Plan, OR switch from Original Medicare to a Medicare Advantage plan. Contact your Health Plans of North Carolina Independent Agent via this website to learn more.