About the Parts of Medicare

About the Parts of Medicare

There's more to Medicare than just the basics; different aspects of your healthcare are covered by different Medicare parts.Medicare coverage is comprised of four parts: A, B, C, and D. Below you'll find information about the qualities of each of those parts. Additionally, there are other types of Medicare health plans - including Medicare Cost Plans such as the one RMHP offers - which we'll explore later.


Medicare coverage parts include original Medicare coverage, hospital care, medical services, and prescription drug assistance under Parts A, B, and D with extra help available. Part C is offered by private insurance providers (also known as Medicare Advantage plans).

ALSO KNOWN AS

Original or Traditional Medicare

WHAT IT PAYS FOR

  • Hospital stays
  • Home health care
  • Hospice
  • Skilled nursing home stays

HOW IT'S PAID FOR

If you or your spouse worked for 10 years and paid the Social Security and Medicare tax, you have already paid for it.

DEDUCTIBLE INFORMATION

  • You will need to pay $1,364 for each covered hospital admissions; then, Medicare will pay for the first 60 days you're in the hospital.
  • If you are hospitalized longer than 60 days, you will incur a cost of $341 per day for days 61-90; beyond 90 days, your "lifetime reserve days" will be initiated. You have a total of 60 of these reserve days in your lifetime and will pay $682/day. Once these are used, you are responsible for all costs.
  • If you have two hospital stays with 60 or more days in between, you will be responsible for the $1,364 deductible each time.
  • The above numbers reflect 2019 amounts.

MAXIMUM OUT-OF-POCKET

(The maximum out-of-pocket is the most you will pay for in-network Medicare-covered services, usually including deductibles)

None. Original Medicare does not cap your out-of-pocket costs.

ALSO KNOWN AS

Original or Traditional Medicare

WHAT IT PAYS FOR

  • Outpatient physician care, meaning any time you see a doctor outside of the hospital
  • Outpatient hospital services
  • Diagnostic services, such as x-ray, labs, and durable medical equipment

HOW IT'S PAID FOR

Premiums are typically deducted from your Social Security benefit check

DEDUCTIBLE INFORMATION

Annual deductible of $185 applies. Once you have met your deductible, Medicare will pay for 80 percent of the Medicare-approved charges. You're responsible for paying the other 20 percent. For example, if your doctor charges you $200/visit, Medicare will pay $160, and you will be responsible for $40. These numbers reflect 2019 amounts.

MAXIMUM OUT-OF-POCKET

(The maximum out-of-pocket is the most you will pay for in-network Medicare-covered services, usually including deductibles)

None. Original Medicare does not cap your out-of-pocket costs.

ALSO KNOWN AS

Medicare Advantage (MA) plans, which are Medicare-approved private health insurance plans for people enrolled in Original Medicare

WHAT IT PAYS FOR

  • Everything covered by Parts A & B
  • Benefits vary, but often vision, dental, and hearing are included
  • Prescriptions are also sometimes included

HOW IT'S PAID FOR

You will pay a monthly premium to the insurance company, which will vary based on the plan coverage you choose.

DEDUCTIBLE INFORMATION

Your deductible will vary based on the plan coverage you choose.

MAXIMUM OUT-OF-POCKET

(The maximum out-of-pocket is the most you will pay for in-network Medicare-covered services, usually including deductibles)

The out-of-pocket maximum will also vary, but unlike Original Medicare, many plans do offer an out-of-pocket maximum. Many people purchase coverage through an insurance company to limit the total amount you'll pay annually for your care.

ALSO KNOWN AS

Prescription Drug Coverage

WHAT IT PAYS FOR

Each Medicare prescription drug plan has its own list of covered drugs, called a formulary. Many formularies utilize tiers, and the cost of a particular drug is determined by which tier it may fall under.

HOW IT'S PAID FOR

You will pay a monthly premium to the insurance company, which will vary based on the plan coverage you choose. The "Extra Help" Prescription Drug Assistance program may help those Medicare Beneficiaries on a limited income, if certain eligibility requirements are met.

DEDUCTIBLE INFORMATION

Not all plans have a deductible, but for those that do, the deductibles vary. However, no Medicare Part D plan can have a deductible more than $415 in 2019.

MAXIMUM OUT-OF-POCKET

(The maximum out-of-pocket is the most you will pay for in-network Medicare-covered services, usually including deductibles)

You will be responsible for a copay or coinsurance for your medications until the real costs of your drugs reach $3,820. Once you reach this amount, you enter the coverage gap, meaning you will pay coinsurance costs for your drugs. Once you have reached a threshold of $5,100 out-of-pocket in 2019, you will no longer be considered in the coverage gap and will automatically receive "catastrophic coverage."  This coverage assumes you only pay a small co-insurance amount or copayment for covered drugs for the rest of the year.

Extra Help for Prescription Drug Costs

Prescriptions can be expensive. That's why there's the Extra Help program available through the government for qualified Medicare beneficiaries. To qualify, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 states or the District of Columbia.

To see if you qualify or for more information, call Social Security at 800-772-1213 (TTY: 800-325-0778) or visit their website.

Learn more about Extra Help

[Please note: By selecting this link you will be leaving RMHP.org]

See What's Next

While each of these parts is an important piece of Medicare coverage, it's time to take a closer look at other types of Medicare plans - including RMHP's Medicare Cost plans.

Explore types of Medicare plans

Medicare Disclaimer

This page was last updated: 10/01/2018.  Please call to confirm you have the most up to date information about our Medicare Cost plans.

H0602_MS_MC2019WEB_1_09252018

Important Disclaimers: RMHP is a Medicare-approved Cost plan. Enrollment in RMHP depends on contract renewal. This information is not a complete description of benefits.  Call RMHP Customer Service at 888-282-1420 (TTY: 711) for more information.  Other pharmacies, physicians, providers are available in our network. Medicare beneficiaries may also enroll in RMHP through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.  For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.   Every year, Medicare evaluates plans based on a 5-star rating system.  If you need help finding a network provider, please call 888-282-1420 (TTY 711) or visit www.rmhpMedicare.org to access our online searchable directory. If you would like a provider directory mailed to you, you may call the number above, request one at the website link provided above, or email customer_service@RMHP.org.

Multi Language Interpreter Service Information (English)

Multi Language Interpreter Service Information (Español)

Other Important Information

Let's Find A Medicare Plan That's Right For You