Medicare is the federal health insurance option for people over the age of 65 with disabilities or who have permanent kidney failure.
If you believe that you qualify for Medicare, it’s important to understand the different plan and enrollment options available to you. Prepare for Open Enrollment now with our guide to 2021 Medicare coverage.
Best Medicare Insurance Options
There are multiple independent companies offering Medicare Part C and Part D plan options. Explore a few of our favorite choices and get a quick quote before Medicare enrollment arrives below.
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How Open Enrollment for Medicare Works
Medicare Open Enrollment is a period of time during which you can enroll in a Medicare Part C or Part D plan. You can’t sign up for Medicare Parts A or B during this period — in most cases, you’ll be automatically enrolled in Medicare once you meet qualification standards.
However, you can use this period to re-evaluate your current coverage and:
- Join or drop a Part D plan if you already have Medicare Parts A and B.
- Switch from one Medicare Advantage plan to another.
- Sign up for a new Medicare Advantage plan.
- Switch from one Part D plan to another.
You can access your Medicare enrollment options and search for plans in your area by visiting Medicare.gov.
Medicare Open Enrollment Periods
Medicare’s Open Enrollment period is held annually from October 15 to December 7. During Open Enrollment, you can make changes to your health insurance beginning on the 1st day of the next calendar year. For example, if you sign onto a new Part D prescription drug plan on November 15, 2020, your coverage will begin on January 1, 2021.
The Average Cost of Medicare in 2021
The price you’ll pay for your Medicare plan and your deductibles, copays and coinsurance will vary depending on a wide range of factors, including which plans you have and the services you use.
Medicare Part A
Most people will pay $0 per month in premiums for Medicare Part A coverage because they paid into Social Security through federal taxes while they were working. If you don’t qualify for premium-free Medicare Part A, you may pay up to $428 per month for coverage depending on how many quarters you paid into Medicare taxes.
Deductibles and coinsurance for hospital services under Medicare Part A are as follows:
- $1,408 deductible for each benefit period
- Hospital stays up to 60 days: $0 coinsurance beyond your deductible
- Hospital stays between 61 and 90 days: $352 coinsurance per day of each benefit period
- Hospital stays beyond 90 days: $704 coinsurance per each “lifetime reserve day,” up to 60 days over your lifetime. After your lifetime reserve days have been exhausted, you are responsible for 100% of your inpatient medical care costs.
Medicare Part B
If you earned $87,000 or less in the previous year, you’ll pay the standard Part B premium of $144.60 per month. Beyond that, your premium will be as follows:
|Filed an individual tax return||Filed a joint tax return||You’ll pay|
|Above $87,000 up to $109,000||Above $174,000 up to $218,000||$202.40 per month|
|Above $109,000 up to $136,000||Above $218,000 up to $272,000||$289.20 per month|
|Above $136,000 up to $163,000||Above $272,000 up to $326,000||$376.00 per month|
|Above $163,000 and less than $500,000||Above $326,000 and less than $750,000||$462.70 per month|
|$500,000 or above||$750,000 and above||$491.60 per month|
The Part B deductible is currently set at $198 per year.
Medicare Part C and D
Because Medicare Parts C and D are offered by independent companies, prices per plan aren’t standardized by the federal government. Your premium, deductible and coinsurance prices can vary depending on where you live, which companies are offering plans near you and which prescription drugs you take.
You can explore a comprehensive list of Medicare Part C and D options available to you through Medicare.gov’s search tool.
There are 4 parts to Medicare: Part A, Part B, Part C (also called “Medicare Advantage”) and Part D. Each part covers a different aspect of healthcare, and premiums for each part may vary widely depending on your income. Medicare Part A and Part B together are sometimes referred to as “Original Medicare” and are the most common choice for Medicare coverage.
Medicare Part A
Medicare Part A covers hospital inpatient stays, limited stays in skilled nursing facilities and mobility devices (like walkers and wheelchairs). If you are physically incapable of visiting a hospital, your Medicare Part A will also cover limited home healthcare services.
Medicare Part A only covers hospital inpatient stays — you aren’t necessarily an inpatient because you arrived at a hospital and received treatment. To be considered an inpatient, you must be formally admitted to the hospital with a doctor’s order.
If you visit a hospital and receive an x-ray, test or emergency care, you’re still considered to be an outpatient visitor — regardless if you spend the night in the hospital or go home after receiving treatment. In these instances, Medicare Part B would cover the cost of your treatment.
Medicare Part B
Medicare Part B is also a portion of Original Medicare and covers expenses for outpatient medical needs. Medicare Part B is most often combined with Medicare Part A. Medicare Part B covers a very wide range of medical services and procedures, including:
- Ambulance and emergency room services administered without a formal hospital admission
- Annual physicals and screenings for diseases like depression and cancer
- Both inpatient and outpatient mental health services
- Medical equipment required to track or monitor a chronic condition (like blood sugar screening devices
- A select number of vision services and prescription drugs
These are just a few examples of the many services covered by Medicare Part B. As a general rule, any medically-necessary doctors’ services that you receive without being admitted to a hospital.
Medicare Part C
Medicare Part C (sometimes called “Medicare Advantage”) are supplemental plans that offer additional coverages and services to your Medicare benefits. In order to qualify for a Medicare Part C plan, you must already have Medicare Part A and Medicare Part B.
Medicare Part C covers additional services not included in the Original Medicare, such as:
- Dental coverage
- Select over-the-counter drugs
- Prescription drugs
- Vision coverage and eyeglasses
- Telehealth services
- Hearing coverage and hearing aids
Medicare Part C plans are administered by independent Medicare-approved health insurance companies. This means that the specific benefits you’ll receive from your Part C plan, and your expenses may vary depending on which plan provider you choose.
Though many Part C plans are available with a $0 monthly premium, you’ll typically need to pay a co-pay each time you visit a doctor or see a specialist. You’ll also be subject to a deductible and an out-of-pocket maximum just like a standard independent health insurance plan. Also like independent health insurance plans, companies offering Medicare Part C plans in your area will vary depending on your ZIP code.
Medicare Part D
Medicare Part D is prescription drug coverage. Though Medicare Part B covers drugs administered in a doctor’s office (like infusions and injected steroids), it typically does not cover other types of prescriptions drugs you’d get from a pharmacy.
If you have Medicare Part C, you typically won’t need an additional prescription drug plan because drugs are usually included in your Part C benefits.
Medicare Part D plan providers each offer their own individual list of generic and brand-name drugs they will cover. These inclusion lists must meet minimum Medicare standards, but they may not include every prescription drug on the market. If you’re already taking a specific prescription drug, you’ll want to be sure that your Part D plan covers it before you enroll.
As a general rule, Part D plan providers are required to cover at least 2 of the most common drugs per category. Part D plan providers must also cover all drugs in the following categories:
- HIV/AIDS treatments
- Antipsychotic medications
- Anticonvulsive treatments for seizure disorders
- Immunosuppressant drugs
- Anticancer drugs (unless the drug is already covered by Part B)
Some drugs (like those used for weight loss or over-the-counter drugs) are specifically excluded from Part D coverage.
What Does Medicare Typically Cover?
Medicare Part A and B cover almost every medical service you might need. Some examples of services that are covered by Original Medicare include:
- Treatments and care needed to manage chronic conditions
- Hospital inpatient stays
- Ambulance services and emergency medical services
- Clinical laboratory tests ordered by your doctor
- Hospice care
- Obesity screenings and behavioral therapy
- Organ transplants and other types of hospital surgeries
This is only a small selection of the many services covered by Medicare Parts A and B. You can view a complete list of Medicare coverages and limitations on select services through Medicare.gov.
What Does Medicare Not Cover?
Though Original Medicare covers most medical treatments and services, it won’t cover everything. Some of the things excluded from Medicare Parts A and B include:
- Prescription drugs. Prescription drugs you take outside of a hospital aren’t covered by Medicare Parts A or B. If you need prescription drug coverage, you should sign onto a Medicare Part D plan during Open Enrollment.
- Cosmetic surgery. Though Medicare will cover the cost of medically necessary reconstructive surgeries following an accident, it won’t cover cosmetic procedures.
- Most dental care. Original Medicare doesn’t cover the cost of cleanings, dental x-rays, fillings, dentures or tooth extractions. Select Part C plans may include coverage for dental care.
- Select home health services. Medicare does cover some forms of home health services, including physical therapy, occupational therapy and part-time skilled nursing services. However, long-term in-home care isn’t covered. Medicare also doesn’t cover services like meal deliveries, homemaker services or 24-7 care services.
- Eye exams related to prescription glasses. Though Medicare does cover eye exams related to diseases like glaucoma, it doesn’t cover eye exams necessary for prescription glasses. Select Medicare Part C plans may include this coverage.
Balance Costs and Care
Enrolling in a Medicare Part C or Part D plan can help you manage your medical expenses and pay less for the services you need to stay healthy. However, plans for these services can vary widely between providers. If you aren’t sure where to begin your search, start with a quick, free quote from Benzinga by entering your ZIP code above.