The ABCs of Medicare: What Recent Retirees Need to Know About Their Coverage Options

Whether you’ve officially retired or are still working full time, it’s possible your health insurance options are changing. Depending on your age or health status, you may soon be qualified for Medicare. While you’ve likely heard of it before, we’re breaking down what exactly it is, who Medicare benefits and what each Medicare part covers.

What Is Medicare?

Medicare is a government-funded national health insurance program that was established in 1966. It is designed to offer coverage to individuals including:¹

Those who are 65 or older
Individuals under 65 with qualifying disabilities
Individuals with End-Stage Renal Disease (ESRD)

Medicare is broken down into several parts that cover specific services. While Part A and Part B are part of the “original” Medicare plan, Parts C and Part D offer optional additional coverage.

Part A: Hospital Insurance

Part A is considered hospital insurance.

As such, it covers hospital-related expenses such as:²

Inpatient hospital care
Skilled nursing facility costs
Hospice
Lab tests
Surgery
Some home health care services

Most beneficiaries don’t pay Part A premiums out of pocket if they or their spouse paid Medicare taxes while working.¹ It’s important to note, however, that annually adjusted standard deductibles still apply.

Many pre-retirees are frequently warned that Medicare Part A will only cover a maximum of 100 days of nursing home care (provided certain conditions are met). Under the current Part A rules, you would pay $0 for days 1-20 of care in a skilled nursing facility (SNF). During days 21-100, a $200 daily coinsurance payment may be required of you.³

Knowing the limitations of Part A, some people look for other choices when it comes to managing the costs of extended care.

Part B: Medical Insurance

Part B is considered the medical insurance portion of Medicare.

It covers expenses like:²

Physicians’ fees
Outpatient hospital care
Certain home health services
Durable medical equipment
Some offerings not covered by Medicare Part A

Part B does come with some costs, however, which are adjusted annually. The premiums vary, according to the Medicare recipient’s income level, but the standard monthly premium amount is $164.90 for 2023, with a yearly deductible of $226.³

Part C: Medicare Advantage

Sometimes called “Medicare Part C,” Medicare Advantage (MA) plans are often viewed as an all-in-one alternative to Original Medicare.

MA plans are offered by private companies approved by the federal government. Although these plans come with standardized minimum coverage, the amount of additional protection offered can differ drastically from one person to the next. This is due to unique provider networks, premiums, copays, coinsurance and out-of-pocket spending limits.

If you’re interested in obtaining a MA plan, you may find it beneficial to compare prices and services offered from different vendors.

Part D: Prescription Drug Coverage

While MA plans often offer prescription drug coverage, insurers also sell federally standardized Medicare Part D plans as a standalone product to those with Medicare Part A and/or Part B.

Every Part D plan has its own list of covered medications. If you're interested in obtaining a Part D plan, Medicare’s website offers the formulary of approved drugs and prices, organized by tier.

If you’re approaching 65 or think you may be otherwise eligible for Medicare, review each part carefully to determine what may work best for you. If you have any questions, your trusted financial professional may be able to help you review your coverage options in detail.

For more information, please contact Stephen Blahovec and Michael Rausch of North River Wealth Advisors. We are an independent, fee-only financial planning and investment management firm located in Pittsburgh, PA servicing clients locally and across the country. To learn more, contact us here.

This content is developed from sources believed to be providing accurate information, and provided by Twenty Over Ten. It may not be used for the purpose of avoiding any federal tax penalties. Please consult legal or tax professionals for specific information regarding your individual situation. The opinions expressed and material provided are for general information, and should not be considered a solicitation for the purchase or sale of any security.