Home › Medicare Clarity Guide › The parts explained
Medicare covers 80%. The other 20% is yours, and it has no ceiling. Here is the whole shape of it, in plain language.
1 · before the details
It is a government program for people 65 and over, and for people under 65 who qualify through a disability or end-stage renal disease.
Here is the whole shape of it first. The pieces make more sense once you have seen where they are going.
2 · the shape of it
The problem is that your 20% has no limit on it.There is no yearly figure after which Medicare picks up the rest.
3 · what that means in real money
Round numbers, to keep it simple. That is a lot of money — and nothing stops it from happening again the following year.
This is a made-up example to show the math, not a real price.
Medicare pays
$80,000
You pay
$20,000
4 · why nobody stops there
It comes from a private insurance company, and there are two ways to do it. Both exist for the same reason: to protect you from that 20%.
A Medicare Supplement
Sits alongside Medicare and pays your share.
A Medicare Advantage plan
Delivers your Medicare through one plan, with a yearly limit built in.
Choosing between them comes later. For now it is enough to know they both exist, and why.
5 · part a
It is listed on your Medicare card. Most people know it covers hospital stays. Fewer know it covers two other things that matter just as much.
Hospital stays
When you are admitted as an inpatient.
Skilled nursing facilities
The place people usually go after leaving the hospital, to recover from an illness, injury or surgery before going home.
Home health care
Being treated at home by nurses after an illness or surgery.
6 · part b
Also listed on your card. This is the part you use in a year when nothing goes wrong.
Doctor visits
Your regular doctor and any specialists.
Testing and outpatient care
Lab work, imaging, and procedures you go home from the same day.
Durable medical equipment
Wheelchairs, oxygen, CPAP machines, and the like.
7 · what it costs each month
One of these you have already paid for. The other arrives every month for the rest of your life.
If you or your spouse worked and paid Medicare taxes for ten years — 40 quarters — Part A costs you nothing each month. You already paid for it.
Most people pay this one, every month. Higher incomes pay more.
8 · what it costs when you use it
A deductible is the amount you pay yourself before that part starts paying. The difference between these two matters more than people expect.
Not once a year. The simplest way to think about it: you pay it every time you go into the hospital for something new.
Once a year, and that is it. Once you have met it, that 80% coverage from earlier kicks in.
9 · where this leaves you
It leaves you exposed to costs you should not have to carry — which is a harder thing to absorb on a fixed income than at any other point in your life.
That is what a supplement or a Medicare Advantage plan is for, along with a prescription plan. Which of those fits you is the next thing worth working out.
A few questions about your situation, then a licensed support agent walks you through what is actually available where you live.
See My Personalized OptionsFree, and there is no obligation to enroll in anything.
