If your drug costs continue to mount, you may reach the point of qualifying for catastrophic coverage. If your total drug costs - the amount you and your Part D insurance plan have paid - reach $4,660 in 2023, you will be responsible for 25 percent of the price of the rest of the prescription drugs you buy during the year. Each generally has premiums and other out-of-pocket costs, either flat copays for each medication or a percentage of the prescription costs. You buy a Part D plan through a private insurer. This is the part of Medicare that pays for some of your prescription drugs. If you go to a provider who is not in the plan’s network, you probably will pay more. Part D - Prescription drugs PPOs have networks of doctors that you can see and facilities you can use, often without needing a referral. In HMOs, you typically choose a primary care doctor who will direct your care and usually will have to give you a referral to see a specialist. Medicare Advantage plans generally are either health maintenance organizations (HMOs) or preferred provider organizations (PPOs). Not all of these plans cover the same extra benefits, so make sure to read the plan descriptions carefully. Most Medicare Advantage plans fold in prescription drug coverage. In recent years, the Centers for Medicare & Medicaid Services, which sets the rules for Medicare, has allowed Medicare Advantage plans to cover such extras as wheelchair ramps and shower grips for homes, meal delivery and transportation to and from doctors’ offices. 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. Then, in addition, you will have to choose a Medicare Advantage plan and sign up with a private insurer. 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. Think of Advantage as a kind of one-stop shopping choice that combines various parts of Medicare into one plan. Medicare Advantage is the private health insurance alternative to the federally run original Medicare. If you are collecting Social Security, the monthly premium will be deducted from your monthly benefit. Part C - Medicare Advantage And you’ll have to pay 20 percent of the bills for doctor visits and other outpatient services. You’ll be subject to an annual deductible, set at $226 for 2023. It may be higher if your income is more than $97,000. The federal government sets the Part B monthly premium, which is $164.90 for 2023. But if you don’t have other insurance and don’t sign up for Part B when you first enroll in Medicare, you’ll probably have to pay a higher monthly premium for as long as you’re in the program. ![]() Unlike Part A, Part B involves more costs, and you may want to defer signing up for it if you are still working and have insurance through your job or are covered by your spouse’s health plan. This part of Medicare covers doctor visits, lab tests, diagnostic screenings, medical equipment, ambulance transportation and other outpatient services. 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. Part B - Doctor and outpatient services There are some exceptions - it won’t pay for a private room, for example. Medicare pays for virtually all hospital services for the first 60 days you’re in the hospital. You can buy a supplemental or Medigap policy to cover that deductible and some out-of-pocket costs for the other parts of Medicare. It changes every year, but for 2023, the deductible is $1,600. Medicare charges a hefty deductible each time you are admitted to a hospital. You’ve already paid into the system in the form of the Medicare tax deductions on your paycheck. Most people don’t have to pay a premium for Part A. It covers hospital stays, hospice care and some skilled nursing care that you may need after being hospitalized for a stroke, a broken hip or other episodes that require rehabilitation in a nursing home or other facility so you can get back on your feet. When you apply for Medicare, you will automatically be enrolled in Part A. To make it easier, the program has been broken down into four basic parts that include coverage for everything from hospital care to doctor visits to prescription drugs. ![]() Centers for Medicare and Medicaid ServicesĮn español | Medicare is complicated and can be confusing to sort through.
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