Insurance and Prescription Drug Coverage

Hospital Insurance

  • Part A covers in-patient hospital stays, short-term care in skilled nursing facilities, hospice care, and some home health care. Part A is free if a person has paid into the Social Security trust fund for 40 quarters, or 10 years

Medical Insurance

  • Part B covers outpatient hospital care, doctor’s visits, laboratory fees, durable medical equipment, and some preventive care like mammograms.  There is a monthly fee for Part B, called a premium
  • Both Part A and Part B have co-payments and deductibles which are the  patient’s responsibility to pay.  A deductible is the amount the patient pays at the start of each year, before Medicare provides coverage.  A co-payment is the amount left for the patient to pay after Medicare pays for a service

Long-Term Care Insurance

  • Medicare does not cover most long-term care, whether in a nursing home, assisted living, an adult day care center, or in your own home.  Private long-term care insurance companies provide coverage to help pay for these services
  • Long-term care policies can differ in important ways.  Not everyone should buy long-term care insurance

Medigap (Supplemental Medicare Insurance)

  • Medigap insurance fills some of the gaps in Medicare coverage, paying for some health care costs that Medicare does not pay.  The more gaps that a Medigap plan covers, the more expensive the policy is to buy
  • Eligibility for Medigap policies can vary.  Plans must offer “guaranteed enrollment” for new Medicare beneficiaries who are turning sixty-five years of age:  the plan cannot refuse to enroll a beneficiary, even if he or she is injured or sick.

Prescription Drug Coverage

  • Part D prescription drug coverage is provided by private insurance companies, subsidized by Medicare.  Coverage ranges from basic to extensive and from low-cost to more expensive. 

 


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