Medicare Plans by Turning 65 Solutions


Parts of Medicare

There are four parts of Medicare. Generally:

  • Part A is inpatient hospital stays
  • Part B is outpatient medical coverage
  • Part C (Medicare Advantage) is an alternative deal to the Original Medicare
  • Part D covers prescription drugs

Parts A and B are considered Original Medicare. Part C, commonly known as Medicare Advantage is sold by private insurance companies like Turning 65 Solutions, and Part D is a stand-alone Medicare plan which you must purchase alongside Part A and B if you want drug prescriptions.

Medicare Part A

Medicare Part A is hospital insurance that covers all services that are related to inpatient care. Therefore, provided coverage under Part A includes:

Inpatient hospital care: This involves all care you receive after a physician admits you into a hospital. Medicare covers up to 90 days for each benefit period in a normal hospital. Additionally, you get 60 lifetime reserve days. Plus, it covers up to 190 lifetime days in a psychiatric hospital that is approved by Medicare.

Skilled nursing facility care: Medicare covers your room and board, and some services provided in a skilled nursing facility. These include tube feedings, wound care, and medications. Medicare covers up to 100 days of each benefit period. In order to qualify, you need to have spent at least three ensuing days in the hospital within 30 days of admission to a skilled nursing facility. Plus, you must have required skilled nursing or therapy services.

Home health care: While Part B typically covers this, Part A coverage will ensue if you have spent at least three successive days in the hospital within 14 days of receiving home care. Medicare covers up to 100 days of daily care or an unlimited amount of periodic care.

Hospice care: Medicare covers hospice care for as long as your provider deems it necessary. You may qualify for hospice care if you are terminally ill with a life expectancy of 6 months, want palliative care instead of hospital care, and refuse treatment in the hospital to cure illness.

Most people qualify for Part A free premium, but you are responsible for Part A hospital deductible which is 1600$ in 2023. When you met the deductible Medicare will provide coverage. 

Medicare Part B

Medicare Part B  is a medical insurance that covers all services that are related to outpatient services and preventive care.  Therefore beneficiaries will be covered under Part B for:

  • Doctor-ordered x-rays and lab tests
  • Provider services that are considered medically necessary
  • Home health services like skilled nursing or therapy care
  • Durable medical equipment that is appropriate for home use ( walkers, scooters, wheelchairs, nebulizers, etc.)
  • Emergency transportation by ambulance
  • Preventative services, like outpatient physical, speech, and occupational therapy
  • Some prescription drugs, such as immunosuppressants and select anti-cancer drugs
  • mental health care and services 

The beneficiaries responsible for the Part B premium are 164.90$ in 2023, and the Part B deductible is 226$. 

Get A Free Quote

Medicare Part C

Medicare Part C, aka Medicare Advantage, is a private health plan that insurance companies provide. These companies are contracted with the federal government.

If you purchase Medicare Advantage, you will still be enrolled in Parts A and B (Original Medicare) and still have to pay for Part B premium plus a premium for your MA plan if required. Even though you still have Original Medicare your Medicare Advantage plan becomes a primary source of coverage. However, these plans often provide additional benefits that Original Medicare does not cover, including:

  • Hearing Aids
  • Vision coverage
  • Dental care and coverage
  • Prescription drug coverage
  • Caregiver counseling and training
  • Gym memberships through SilverSneakers

Medicare Advantage plans often have limited network coverage. That means that you must only go to doctors and hospitals that are contracted with your specific plan. Some plans like PPO,  allow policyholders to go out-of-network, but they will definitely pay higher out-of-pocket costs. Additionally to. that, you often may need a referral to see a specialist. The most popular Medicare Advantage plans are Preferred Provider Organization, High Maintenance Organization, Point of Service, Special Needs Plan, and Private Fee For Service plans.

Medicare Part D

Medicare Part D is prescription drug coverage. It covers most outpatient prescription drugs. Private insurers offer Part D either as an independent plan or as a group of benefits contained with a Medicare Advantage plan.

Every Part D plan has a formulary, which is a list of drugs that are covered. If the drug you require is not on the formulary, you may request an exception, pay out of pocket, or submit an appeal to include the drug in your coverage.

The formularies vary from plan to plan, so you should request a copy. But each plan has to cover all drugs in these categories:

  • Antidepressants
  • HIV/AIDS treatment
  • Immunosuppressants
  • Antipsychotic medications
  • Anticonvulsive treatments for seizure disorders
  • Anticancer drugs (unless they are being covered under Part B)

Also, Part D covers most vaccines unless they are already covered under Part B. In 2023, the average monthly premium cost of prescription drugs is 43$. Always check a list of the drugs on the formulary before you are enrolling in a specific plan. It makes it easier to choose the best plan which suits your medication needs. 

If you hadn’t a creditable coverage before and missed your Initial Enrollment period to enroll in your Part D plan you may pay a Part D enrollment penalty. Your IEP is different for every individual and starts three months before you. turn 65 and lasts 3 months after your 65th birthday.

If you are considering enrolling in a Medicare Advantage plan, or Part D plan, or have general questions about your Medicare coverage contact our experienced brokers for more information at 830-328-4353. We know that Medicare can be tricky, so we will be eager to help!