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When you apply for Medicare, you will automatically be enrolled in Part A. It covers hospital stays, hospice care and some skilled nursing care that you may need after being hospitalized or other episodes that require rehabilitation in a nursing home or other facility.
Most people don’t have to pay a premium for Part A. You’ve already paid into the system in the form of the Medicare tax deductions on your paycheck.
However, Part A isn’t totally free.
Medicare charges a hefty deductible each time you are admitted into the hospital. It changes every year. You can buy a supplemental or Medigap policy to cover that deductible and some out-of-pocket costs for the other parts of Medicare.
Medicare pays for virtually all hospital services for the first 60 days you’re in the hospital. There are some exceptions.
If you are a U.S. citizen or permanent resident and have not worked long enough to qualify for Medicare, you may able to buy into the program by paying a Part A premium.
Doctors and services
This part of Medicare covers doctor visits, lab tests, medical equipment, ambulance transportation and other outpatient services.
Unlike Part A, Part B involves more costs, and you may want to defer signing up for Part B if you are still working and have insurance through your job.
You’ll also be subject to an annual deductible and you’ll have to pay 20 percent of the bills for doctor visits and other outpatient services. If you are collecting Social Security, the monthly premium will be deducted from your monthly benefit.
If you decide on a Medicare Advantage — or MA — plan, you’ll still have to enroll in parts A and B and pay the Part B premium. Then, in addition, you will have to choose a Medicare Advantage plan and sign with a private insurer.
The federal government requires these plans to cover everything that original Medicare covers, and some plans pay for services that original Medicare does not, including dental and vision care. In addition, in recent years, the Centers for Medicare and Medicaid Services, which sets the rules for Medicare, has allowed Medicare Advantage plans to cover extras.
Most Medicare Advantage plans also fold in prescription drug coverage. Not all the plans cover the same extra benefits, so make sure to read the plan descriptions carefully.
Medicare Advantage plans generally are either health maintenance organizations (HMOs) or preferred provider organizations (PPOs).
In HMOs you typically choose a primary care doctor who will then direct your care and usually will have to give you a referral to see a specialist. PPOs have networks of doctors that you can see and facilities you can use, often without the need of a referral.
Prescription Drug Plans
This is the part of Medicare that pays for some of your prescription drugs.
Each generally has some premiums and other out-of-pocket costs, either flat co-pays for each medication or a percentage of the prescription costs. They also may have an annual deductible.
If you have high prescription drug bills, you may be subject to the Medicare coverage gap, commonly known as the doughnut hole.
Once you and your drug plan have incurred a certain amount of expense for your drugs, you’ll have to pay no more than 25 percent of the cost of brand-name prescription drugs and 37 percent of the price of generic drugs.
Be sure to check at Medicare.gov whether the plan you’re considering has the medicines you take on their covered lists — called formularies. Those lists change from year to year, so it’s important to recheck your plan every year at open enrollment time — from Oct. 15 to Dec. 7.
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