Medicare Explained

Medicare can be a complex topic, but with Thomas Family Insurance, we can help break it down so you are fully aware of your options.

The Parts of Medicare

Part A: Hospital Insurance. Part A covers inpatient care in a hospital, skilled nursing facility, or nursing home, as well as hospice care and home health care.

Part B: Medical Insurance. Part B covers medically necessary and preventive services, which include coverage for clinical research, ambulance services, durable medical equipment, mental health, and limited outpatient prescription drugs.

Part C: Medicare Advantage. Medicare Advantage plans are provided by private companies which are compensated by Medicare to handle your Part A and Part B coverage. These plans often offer prescription drug coverage and may have coverage for dental, vision, or hearing care.

Part D: Prescription Drug Plans. Offered separately from Original Medicare (A+B), these plans cover prescription drugs, for which you will pay a copayment based on whether the prescription is generic, brand name, or specialty, as well as whether or not the drug is preferred.

Medigap: Medicare Supplements. These are standardized plans offered by private companies to help cover the expenses associated with your Part A and Part B healthcare costs.

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What does Medicare not cover?

Original Medicare (Part A and Part B) does not have coverage for routine care related to podiatry, dental health, hearing, or vision. It does not subsidize the purchase or fittings for hearing aids, dentures, contacts, or eyeglasses. 

If you have a medical procedure related to one of these areas and become an inpatient in a hospital, Part A will cover your inpatient expenses beyond your deductible. Part B will cover medically necessary treatment for foot care caused by injuries or diabetes-related nerve damage. Diagnostic hearing and balance exams are covered when your provider orders them to see if you need medical treatment. Your regular Part B expenses will apply.

What are the costs of Original Medicare?

Many people receive Part A without having to pay premiums. You fall into this category if you qualify for retirement benefits, have received disability benefits for a specified length of time, have worked and paid payroll taxes for a specified number of work credits, or were a government employee. If you do not qualify for premium-free Part A, you can purchase it as long as you are 65 or older and have legally resided in the U.S. for five years. Monthly premiums for people who worked (or whose spouse worked) between 30 and 39 calendar quarters while paying taxes are $259. Those with fewer than 30 calendar quarters will pay $471 each month for Part A. 

Everyone pays monthly premiums for Part B. The cost of premiums depends on the income you file on your tax report, either single, jointly, or married but filing separately. The standard Part B premium for 2021 is $148.50. Those with incomes higher than $88,000 as an individual or $176,000 as a couple will pay more for Part B.

For more information regarding the costs and coverage of Medicare, reach out to Thomas Family Insurance today! We serve Illinois, Missouri, and Iowa and can find you a plan in your specific area.