Medicare Parts A, B, C (Advantage), and D

Since 1965, Medicare has been the United States’ federally funded health insurance program primarily offered to citizens who are 65 years and older, have a disability, or suffer from End-Stage Renal Disease (ESRD) [1]. Medicare has four parts: A (hospital insurance), B (medical insurance), C (Medicare Advantage), and D (prescription drug coverage) [2]. 

Medicare Part A covers medically necessary services, including inpatient hospital visits, some lab tests, surgeries, nursing facility care, and certain home healthcare services [1]. Nearly all costs incurred during the first 60 days of a hospital visit will be covered by Medicare Part A [2]. Because it is oriented toward treating emergency conditions rather than preventing them, Part A does not include preventative healthcare, such as diagnostic screenings, yearly wellness visits, and influenza vaccinations [2, 3]. People will automatically receive these benefits if they have been receiving Social Security or Railroad Retirement Board benefits at least four months before they turn 65, or if they have a disability, amyotrophic lateral sclerosis (ALS), or ESRD [4]. 

While most Part A beneficiaries do not have to pay a premium, those who have not paid Medicare taxes for ten years before enrollment and/or have certain disabilities will have to pay a premium [2, 5]. In 2021, monthly premium rates start at $259 for those who have contributed to Medicare taxes for 30 quarters or are married to someone who has [5]. People who do not meet either of those stipulations will face a starting premium rate of $471 [5]. 

To receive preventative healthcare, Medicare beneficiaries must enroll in Part B. Part B covers many services that Part A does not, including disease screenings, shots, and ambulance transportation [2, 3]. Because of these additional benefits, Medicare enrollees generally opt to pay more for their healthcare [2]. The monthly premium for Part B begins at $148.50 [2]. Part B members also have to pay an annual deductible, which has been set at $203 for 2021, as well as 20% of bills for primary care physician and outpatient visits [2]. 

Despite Part B’s preventative healthcare benefits, it does not cover certain key services, such as most vision and dental care, hearing aid services, and long-term care [1]. Alongside these benefits, Part C, known as Medicare Advantage (MA), covers everything that Parts A and B cover [2]. Eligibility for Part C is similar to that for Parts A and B; however, enrollees must also reside within the coverage area of their insurance provider and not have ESRD [6]. 

People who wish to receive Medicare Advantage benefits must enroll in Medicare A and B, pay the Part B monthly premium, and buy an MA plan from a private insurer [2]. 40% of Part C enrollees pay other premiums in addition to Part B premiums [7]. In 2021, the average monthly charge for an MA plan that includes prescription drug coverage is $21 [1]. 

Part D offers enrollees prescription drug coverage [1]. It is administered via private companies and requires an additional application to enroll [1]. Different monthly premiums and out-of-pocket costs apply to individual plans [2]. If a beneficiary’s drug costs amount to at least $4,130 in 2021, they will be personally responsible for only 25% of any additional cost of prescription drugs for the rest of the year [2]. Likewise, if drug costs reach $6,550, a beneficiary will need to pay only 5% of additional costs [2]. 

Medicare plan suitability is dependent on various factors, including an individual’s current health status, hospital care, prescription drug costs, and finances.  

References 

[1] M. Rubin, “An Introductory Guide to Medicare Parts A, B, C, and D,” The Balance, Updated January 5, 2021. [Online]. Available: https://www.thebalance.com/an-introductory-guide-to-medicare-parts-a-b-c-and-d-2894259. 

[2] D. Bunis, “Understanding Medicare’s Options: Parts A, B, C and D,” AARP, Updated January 1, 2021. [Online]. Available: https://www.aarp.org/health/medicare-insurance/info-01-2011/understanding_medicare_the_plans.html. 

[3] Medicare, “Preventive & screening services,” Medicare.gov. [Online]. Available: https://www.medicare.gov/coverage/preventive-screening-services/. 

[4] Medicare, “How do I get Parts A & B?,” Medicare.gov. [Online]. Available: https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b. 

[5] CMS, “2021 Medicare Parts A & B Premiums and Deductibles,” Centers for Medicare & Medicaid Services, Updated November 6, 2020. [Online]. Available: https://www.cms.gov/newsroom/fact-sheets/2021-medicare-parts-b-premiums-and-deductibles. 

[6] Journal of Oncology Practice, “Overview of Medicare Parts A-D,” Journal of Oncology Practice, vol. 5, no. 2, p. 86-90, March 2009. [Online]. Available: https://doi.org/10.1200/JOP.0922502. 

[7] M. Freed, A. Damico, and T. Neuman, “A Dozen Facts About Medicare Advantage in 2020,” KFF, Updated April 22, 2020. [Online]. Available: https://www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage-in-2020/.