What are the Different Parts of Medicare and What is Right for Me?

Understanding Medicare Benefits

Medicare consists of several parts, each designed to cover different healthcare services and expenses. Understanding what each part covers can help you evaluate your coverage options. 

Part A: Hospital care, skilled nursing care, hospice care, and home healthcare

  • Free if either you or your spouse paid Medicare payroll taxes for at least 10 years.

Part B: Physician’s fees and outpatient services

  • Premium subject to your income.
  • Premium penalty if you enroll late.

Part C: Advantage Plans – health plan options

  • Plans developed by private insurance companies to provide comprehensive coverage.
  • These plans will look similar to what you had in your working years (available options: HMOs, PPOs, PFFs, Special Needs).
  • The amount of options you have available depends on the size of the market you live in. Plan availability, provider networks, premiums, and benefits vary by location and insurer.
  • Costs vary by plan.

Part D: Prescription drugs

  • Premium penalty if you enroll late.

Once you understand the four parts of Medicare, it’s important to know how they work together and the different coverage options available.

Original Medicare (Parts A & B)

  • Part B is an 80/20 coinsurance plan forever; there is no maximum out-of-pocket coverage.
  • You may want to consider additional supplemental coverage to cover many of the out-of-pocket costs associated with Parts A and B. 

Common Coverage Paths

  • Part A + Part B + Part D + Medigap/supplement plan
  • Part C + Part D
      • Part D is included with some Advantage Plans (Part C), if it is not included with your plan, it should be
        purchased separately.
      • Contact EWM to discuss how healthcare and Medicare-related costs may fit into your overall retirement and
        financial planning.

Health Savings Accounts (HSAs) and Medicare

  • Individuals enrolled in Medicare generally may not make new HSA contributions.
  • Once Social Security starts, Medicare enrollment (Part A) is automatic, and HSA contributions must stop.

COBRA & Medicare

  • Individuals considering COBRA continuation coverage after age 65 should carefully evaluate Medicare enrollment requirements and applicable enrollment periods, as delaying Medicare enrollment in certain circumstances may result in penalties or coverage gaps.
  • If you are over 65, stop working, and elect COBRA coverage, you must enroll in Medicare before the end of the 8th month after leaving your employer plan. If you wait until COBRA ends, you will miss your Special Enrollment Period.
  • For spousal coverage, additional complexities arise. Contact an EWM advisor to review your situation.
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IRA-to-HSA Rollover Solution
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Disclosures: Information contained herein is intended for informational, illustrative and/or educational use only and not designed to be a recommendation for any specific investment product, strategy, plan feature or other purpose nor shall it be construed to be the provision of individualized investment, tax or legal advice. Endowment Wealth Management, Inc. (“EWM”) is not soliciting or recommending any action based on this material. This is neither an offer nor a solicitation to buy/or sell securities in any state or jurisdiction where EWM is not registered, or notice filed and does not qualify for an exemption from such registration and notice filing requirements. Prior to making any investment or financial decisions, an investor should seek individualized advice from a personal financial, legal, tax and other professional advisors that consider all of the particular facts and circumstances of the investor’s own situation. All investments involve risk and potential loss of capital and, unless otherwise stated, are not insured or guaranteed.

While the content herein has been obtained from sources that we consider reliable, we do not represent that the information is accurate, complete, or current and it may be relied upon as such. Reliance upon any information in this material is at the sole discretion of the reader. Content is subject to change without notice.

The information presented is provided for educational and illustrative purposes only and is intended to provide a general overview of Medicare coverage options, enrollment considerations, and related planning topics. Medicare coverage decisions are highly individualized and depend on factors such as health status, prescription drug needs, provider preferences, geographic location, employer coverage, income, and other personal circumstances

This material should not be construed as individualized Medicare, insurance, legal, tax, or financial advice. Medicare rules, premiums, penalties, enrollment requirements, and plan offerings may change over time. Individuals should consult with Medicare, licensed insurance professionals, their benefits administrator, or other qualified professionals regarding their specific situation before making coverage or enrollment decisions.

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