Medicare Coverage Options

Complete guide to Medicare Parts A, B, C, and D

Understanding Medicare Parts

Part A - Hospital Insurance

Covers inpatient hospital care, skilled nursing facilities, hospice care, and some home health services.

  • • 60 days of inpatient hospital care ($0 deductible)
  • • 90 days of skilled nursing ($199 deductible)
  • • Unlimited hospice care
  • • Most people get Part A premium-free

Part B - Medical Insurance

Covers medically necessary services like doctor visits, outpatient care, and preventive services.

  • • Doctor visits and specialist care
  • • Outpatient hospital services
  • • Physical/occupational therapy
  • • Medical equipment and supplies
  • • Monthly premium: $174.70 (2024)

Part C - Medicare Advantage

Private insurance plans that replace Original Medicare, offered by approved private companies.

  • • Includes Parts A and B coverage
  • • Often includes Part D (prescription drugs)
  • • May include extra benefits (dental, vision, hearing)
  • • HMO, PPO, or PFFS plan options
  • • Open Enrollment: January 1 - March 31

Part D - Prescription Drugs

Helps pay for prescription medications through private insurance companies.

  • • Coverage for brand-name and generic drugs
  • • Monthly premium varies by plan
  • • Annual deductible ($505 max in 2024)
  • • Coverage gap (donut hole) protection
  • • Open Enrollment: October 15 - December 7

Medicare Enrollment Timeline

Initial Enrollment Period

3 months before 65th birthday through 3 months after. No penalty.

General Enrollment Period

Jan 1 - Mar 31. May incur late enrollment penalty.

Special Enrollment Period

Available with qualifying life events (losing coverage, moving, etc.)

Medicaid

State and federal program for low-income individuals and families

Eligibility & Coverage

  • Income Limits: Vary by state and household size. Generally 138% of federal poverty level.
  • Asset Limits: Limited assets allowed ($2,000 for individual, $3,000 for couples).
  • Coverage Includes: Nursing home care, home health services, personal care assistance.
  • Medicare Savings Programs: Help pay Medicare premiums and cost-sharing for low-income beneficiaries.

State Variations

Medicaid rules vary by state. Contact your local Medicaid office for specific requirements.

Qualified Medicare Beneficiary (QMB)

Pays Medicare Part B premiums, deductibles, and coinsurance. Income limit: 100% FPL.

Specified Low-Income Medicare Beneficiary (SLMB)

Pays Medicare Part B premiums. Income limit: 120% FPL.

Qualifying Individual (QI)

Pays Medicare Part B premiums. Income limit: 135% FPL.

Long-Term Care Insurance

Planning for potential long-term care needs

What It Covers

  • Nursing Home Care: Skilled nursing facility stays
  • Home Health Care: Skilled nursing, therapy, and medical social services at home
  • Adult Day Care: Supervised adult day care services
  • Assisted Living: Care in assisted living facilities

Important Considerations

Eligibility Age

Must be at least 18 (preferably 40-60) to purchase long-term care insurance.

Premium Factors

Age, health status, coverage amount, and elimination period affect premiums.

Inflation Protection

Consider policies with automatic benefit increases to keep pace with rising costs.

Tax Benefits

Premiums may be tax-deductible, and benefits are generally income tax-free.

When to Buy Long-Term Care Insurance

The best time to purchase is between ages 40-60 when you're generally healthier and premiums are lower.

  • • Shop around and compare multiple policies
  • • Work with a licensed insurance agent specializing in LTC
  • • Consider your health, family history, and financial situation
  • • Review policy features: benefit amount, elimination period, inflation protection

Supplemental Insurance

Additional coverage options to supplement Medicare

Medigap Plans

Fill the gaps in Original Medicare coverage. Standardized plans A through N.

  • • Covers Part A deductible
  • • Pays Part B coinsurance
  • • Covers skilled nursing coinsurance
  • • Available in all states

Dental Insurance

Coverage for dental cleanings, fillings, crowns, and oral surgery.

  • • Preventive care coverage
  • • Major dental work
  • • Often requires waiting periods
  • • Check for Medicare Advantage inclusion

Vision Insurance

Covers eye exams, glasses, and contact lenses.

  • • Annual eye exams
  • • Lens and frame allowances
  • • Contact lens coverage
  • • May include glaucoma screening

Hearing Insurance

Coverage for hearing aids and related services.

  • • Hearing aid devices
  • • Fitting and adjustments
  • • Repairs and maintenance
  • • Limited annual allowances

Critical Illness Insurance

Lump-sum payment for covered critical illnesses.

  • • Cancer, heart attack, stroke
  • • Tax-free lump sum payment
  • • Use funds as needed
  • • Supplement other coverage

Accident Insurance

Coverage for accidental injuries and related medical expenses.

  • • Emergency room visits
  • • Ambulance transportation
  • • X-rays and lab work
  • • Surgical expenses

Explore More Resources