Medicare can be exceptionally complicated, one area that is consuming for most people are the different
Medicare Parts:  A, B, C, and D.

Medicare Part A

Medicare Part A is hospital coverage. 

This part covers all things associated with hospital stays including semi-private room, meals, nursing, hospital services, supplies, and hospice.  It also covers skilled nursing facility care and home healthcare under limited circumstances. 

Unfortunately none of these coverages are unlimited, nor completely covered as there are co-pays. 
These benefits are based on your benefit period. 
Medicare will only cover 60 days in the hospital or 100 days in a skilled nursing facility per benefit period. 
In other words, Medicare can cover the maximum number of days multiple different times, as long as the Medicare recipient is in a new benefit period. 
The benefit period starts the first day of inpatient hospital services or skilled nursing care as a resident of a skilled nursing facility.
The benefit period ends after 60 consecutive days pass while not being a hospital inpatient or receiving skilled nursing care as a resident in a skilled nursing facility. 

For example, if Jane falls and goes into the hospital on January 1, 2020 and goes home on January 19, 2020, she will have a new benefit period on March 20, 2020 (60 days after being discharged from the hospital) and can go into the hospital again April 1, 2020 for a full 60 days. 

Another example is John who went to the hospital on January 1, 2020 and was discharged to a skilled nursing facility on January 5, 2020.  After being in the skilled nursing facility for 100 days, Medicare stopped paying for his skilled nursing. 
After one year, he was discharged home. 
A month later he had another fall and was sent back to skilled nursing after the hospital. 
Medicare would not cover the skilled nursing because John was not home for 60 days without a hospital or nursing facility stay.

To be eligible, an individual must either be 65 or have been declared disabled by the Social Security Administration for a period of 24 months.  For most individuals, there is no premium.

Medicare Part B

Medicare Part B is medical insurance which broadly covers doctors’ services, outpatient medical and surgical services and supplies, diagnostic tests, outpatient therapy, outpatient mental health services, preventative health care services, clinical laboratory tests, durable medical equipment, outpatient hospital services, and ambulance services (if other transportation would endanger health). 
Like with Part A, Part B does not offer unlimited coverage, it has co-pays which are 20% for most services.

To be eligible, an individual must either be 65 or have been declared disabled by the Social Security Administration for a period of 24 months.  For most individuals, there is a premium of $170.10 (2022) per month. 
It is critical that you enroll in Part B when becoming eligible. 
Although there are exceptions for individuals still working at 65 and receiving health insurance through a large employer, they are complex and I would encourage you to speak to a Medicare specialist.   
If you do not enroll when you are required to, the premium increases 10% for each year you do not enroll after becoming eligible.  The increased premium due to the penalty is permanent, meaning you will pay a higher rate for the rest of your life.

Medicare Part D

You can see I skipped Medicare Part C; which I will be discussing last as Part C is really a combination of Parts A, B, and D. 

Medicare Part D is prescription drug coverage. 
Prescription drug coverage under Part D is optional and there is a premium associated with it which varies depending on the plan you choose.  
In addition to each plan having a different premium, each plan covers different drugs. 
The drugs covered under a particular plan are known as a formulary. 
As such, it is critical to make sure your drugs are covered by the formulary of the Part D plan you are choosing. 
Part D does not cover your drugs in full; there are co-pays and deductibles associated.

Like Part B, Part D premium will be increased permanently by a penalty if you do not enroll in Part D when you are first eligible. If you have equivalent coverage from an employer at the time you would become eligible, you are permitted to keep that coverage but must enroll in Part D when you no longer have the sufficient coverage.

Medicare Part C

Some individuals elect to not have original Medicare Parts A, B, D, and a supplemental plan to cover the Medicare co-pays and deductibles, and instead elect to have all encompassing Medicare Part C or “advantage” plan. 
The biggest difference here is that you have an insurance company which provides you a prescribed set of benefits but requires you to use doctors in their network and you typically need prior authorizations to see specialists.

Dual Eligibles

Individuals who meet the requirements can be eligible for both Medicare and Medicaid; these individuals are known as dual eligibles.  The reason an individual may want to be dual eligible is because Medicare only covers 80% of their medical expenses, the other 20% is their responsibility. 
Eligible individuals rely on Medicaid to cover the remaining 20% that is not covered by Medicare.

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All people, regardless of their financial situation, deserve a fair shot at justice – and that requires legal help. 
It’s not justice when a senior or disabled person is denied health care services or a family loses their home simply because they couldn’t afford the legal help they needed. 
Central Jersey Legal Services provides access to legal help and information for clients in life-changing legal situations who could not otherwise afford an attorney.

The purpose of this article is to present a general overview of the Parts of Medicare. It is not intended to be used as legal advice.  Each client’s case is unique and merits individual substantive and procedural legal advice from an attorney.

 This article was authored by Ryann M. Siclari, Esq.  Edited by Chané M. Jones, Esq.