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 - that we'll explore later.

Medicare parts

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 $1,316 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 $329 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 $658/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 $1,316 deductible each time.
  • The above numbers reflect 2017 amounts.
OUT-OF-POCKET MAXIMUM
(The out-of-pocket maximum 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 $183 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 $100/visit, Medicare will pay $80, and you will be responsible for $20. These numbers reflect 2017 amounts.

OUT-OF-POCKET MAXIMUM
(The out-of-pocket maximum 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.

OUT-OF-POCKET MAXIMUM
(The out-of-pocket maximum 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 $400 in 2017.

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

You will be responsible for a copay for your medications until the real costs of your drugs reach $3,700. Once you reach this amount, you enter the coverage gap, meaning you will pay coinsurance costs for your drugs. Once you have reach a threshold of $4,950 out-of-pocket in 2017, 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]

2017 Limited Income Subsidy Premiums - Denver Metro  2017 Limited Income Subsidy Premiums - Front Range  2017 Limited Income Subsidy Premiums - Western Slope

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: 01/06/2017.  Please call to confirm you have the most up to date information about our Medicare Cost plans.

H0602_MS_MC500WEB_RMHP3 Approved

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.  Contact the plan for more information.  Limitations, copayments, and restrictions may apply.  Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year.  You must continue to pay your Medicare Part B premium.  This information is available for free in other languages.  Please call our customer service number at  888-282-1420 (TTY dial 711). Hours are 8am - 8pm, 7 days/week, Oct. 1–Feb.14, and 8am - 8pm, M-F, Feb.15–Sept.30. Esta información está disponible gratuitamente en otros idiomas. Por favor llame a la línea de Atención a Clientes, al 888-282-1420 (TTY marque 711). Horario  de 8am - 8pm, 7 días a la semana, del 1 de octubre al 14 de febrero; y de 8am - 8pm, de lunes a viernes, del 15 de febrero al 30 de septiembre.  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.  This is not a complete listing of plans available in your service area.  For a complete listing 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.  Medicare evaluates plans based on a 5-star rating system.  Star Ratings are calculated each year and may change from one year to the next.  The formulary, pharmacy network, and/or provider network may change at any time.  You will receive notice when necessary.  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. 

Other Important Information

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