YT YouTube2Text

YouTube2Text → Transcripts → Medicare Parts A B C D Explained - Everything you need to know!

Medicare Parts A B C D Explained - Everything you need to know! — Transcript

by Medicare Specialist - Abt Insurance Agency · 4,250 words · 618 segments · language en · Watch on YouTube

Open in transcriber Summarize with AI Download SRT/VTT

Full transcript

0:00Today I'm breaking down the four main
0:01parts of Medicare, parts A, B, C, and D
0:05for 2026. We're going to review who
0:08actually needs Medicare and who doesn't.
0:11We'll review the costs associated with
0:13each part of Medicare, which some costs
0:16are dependent upon your income. We'll
0:18review how these parts of Medicare
0:19actually work in practice, as well as
0:22review the main choices that you have to
0:24make when it comes to these parts of
0:26Medicare. And you do have to make some
0:28pretty important choices. So, if you are
0:30turning 65, you know someone who's going
0:32on to Medicare, or you just need a
0:34little refresher, this is the video for
0:36you. Hi, my name is Stephanie Apt. I am
0:38a licensed independent Medicare
0:40insurance broker. My team and I help
0:41seniors all over the country to
0:43understand and navigate the world of
0:45Medicare. Today, I'm going to explain
0:46the four main parts of Medicare. And you
0:49really, you want to think of this as
0:50Medicare translated. I know how
0:52confusing all of these different parts
0:54of Medicare can be and I want to break
0:56it down into simple, easy to understand
0:58terms for you. If you're not familiar,
1:00Medicare is a government health
1:02insurance program for people aged 65 and
1:04over and certain people under 65 with
1:07disabilities. You're generally eligible
1:09for Medicare on the first day of the
1:11month that you turn 65. And while we're
1:14breaking down four parts of Medicare
1:16today, A, B, C, and D, really the two
1:19main parts to Medicare are part A and B.
1:22This is what's known as traditional
1:24Medicare or original Medicare. So, let's
1:26start with part A. Part A is your
1:28hospital insurance coverage. For most
1:30people, Medicare Part A is free as long
1:33as you've been living working in the US
1:35for about 10 years or 40 quarters. So
1:37Medicare Part A is going to cover your
1:39inpatient hospital stay, things like
1:41skilled nursing facility care, and then
1:43there's Medicare Part B. Medicare Part B
1:46is your medical insurance, also known as
1:48your doctor insurance. And Medicare
1:50PartB isn't free. Most people do have to
1:52pay a monthly premium cost to be
1:55enrolled in Medicare Part B. And in
1:572026, most people will pay $22.90
2:01per month to be enrolled in Medicare
2:04PartB, although some people might pay
2:06more. Medicare Part B is income
2:09dependent. So, there is a chart on the
2:11screen right now that reviews Irma, also
2:14known as income related monthly adjusted
2:17amounts for both Medicare Part B, your
2:21medical insurance, as well as Medicare
2:23Part D, your prescription drug
2:25insurance. And we're going to get to
2:27Medicare Part D a little bit later in
2:29this video. What you need to know right
2:31now is that depending upon your adjusted
2:34gross income on your tax return for
2:362024, Medicare will looks at that number
2:40to determine your 2026
2:43Part B and Part D premiums. A lot of
2:46people will say to me, well, in 2024,
2:49you know, my life was different than it
2:50is now in 2026. Maybe then I was working
2:53and now I've retired. So, there is a way
2:56to appeal these Irma charges. There's an
3:00Irma appeals form that you can use. I've
3:02linked it in the video description below
3:04where you can check a box stating that
3:06you've had a life change. You can
3:08provide proof of that change. And
3:11typically, Medicare will lower your
3:14premium as long as you have reasonable
3:16proof of that life change. If you're
3:18someone that's needing to appeal these
3:19Irma charges, I found the best way to do
3:22it is to go down in person to your local
3:24Social Security office. Now, you don't
3:26have to. You can also mail in this
3:28appeals form, but if at all possible to
3:31get an appointment at the Social
3:32Security office, that's typically the
3:35best way to get your Irma waved or
3:39lowered if you've had a life change. So,
3:41like I mentioned before, Medicare Part A
3:43and Part B are the two parts of original
3:47Medicare, right? And you're eligible
3:49generally the first day of the month
3:51that you turn 65. However, not everyone
3:54who's turning 65 needs to or should
3:58enroll in Medicare. And I know that when
4:00you're approaching turning 65, you start
4:01to get a ton of mail phone calls. You're
4:05seeing all of these warning symbols. You
4:06have to apply for Medicare or else
4:08you'll get a penalty when you're turning
4:1065. However, what many people don't
4:12realize is that if you are still
4:14actively working past age 65, you have
4:18health insurance through your employer
4:21and your employer has 20 or more
4:24employees, then you can and often should
4:28delay enrolling in Medicare and you
4:30won't get penalized. You should at least
4:32delay enrolling in Medicare Part B since
4:35Part B comes with a monthly premium. And
4:38if you're still working and you have
4:40health insurance through your job,
4:42generally you don't need Medicare parts
4:44A and B, it doesn't coordinate benefits
4:46well with your employer insurance and
4:48it's typically not to your advantage to
4:50have it. Again, you would have to meet
4:52all of these criteria in order to delay
4:56Medicare past age 65. And I do have a
4:59video that I've linked below that goes
5:01into more depth about delaying Medicare,
5:04what to do when you're ready to enroll
5:07in Medicare. if you're past age 65. So,
5:10be sure to check that out if this sounds
5:11like you. Also important to note that
5:14being selfmployed or being on COBRA
5:18coverage or being on a retiree health
5:21plan doesn't count as creditable
5:24coverage generally for delaying
5:26Medicare. So, in other words, if you are
5:29on COBRA or you have a retiree health
5:31plan, you generally do have to apply for
5:34Medicare when you're very first eligible
5:36at age 65 or you could face penalties
5:39down the road. Okay, so let's say you do
5:41want to apply for Medicare at age 65.
5:44How do you do that? Well, what you'll
5:46want to do is enroll in Medicare during
5:48your initial enrollment period. This is
5:51a 7-month window. It starts 3 months
5:53before the month you turn 65. includes
5:56your 65th birth month and goes up to 3
5:58months after the month you turn 65. And
6:01during this initial enrollment period
6:04window, you can apply for any of the
6:06parts of Medicare, part A, B, C, and or
6:10D. If you apply before your 65th birth
6:13month, then coverage will start on the
6:15first day of the month that you turn 65.
6:17But if you ever get to, you can apply
6:19within your birth month and up to 3
6:21months after. and coverage generally
6:23starts the first day of the following
6:25month. If you're someone that is drawing
6:27social security benefits prior to
6:30turning 65, then Medicare actually
6:32automatically enrolls you in parts A and
6:34B. You don't have to do anything.
6:36Medicare will send you your red, white,
6:38and blue Medicare card in the mail.
6:41You'll usually get it a few months
6:42before you turn 65, and you don't have
6:45to apply for parts A and B online. Along
6:47with that red, white, and blue card that
6:49they send you, they also send you a form
6:52where you can fill it out to decline
6:54Medicare Part B if you don't want or
6:57need it yet. And if you're not yet
6:59drawing Social Security benefits, then
7:01you do actually have to apply online for
7:05original Medicare parts A and B. And you
7:07can do that at ssa.gov/medare.
7:11You'll have to create a social
7:13security.gov account if you don't have
7:15one already. And this is the application
7:17that you'll use to apply for Medicare
7:19parts A and B. Now, this application
7:22won't ask you if you want part C or part
7:25D or a Medicare supplement plan. You
7:27don't need to know any of that yet. Just
7:29want to use this online application to
7:31apply for Medicare parts A and B.
7:34Additionally, if you only want to apply
7:36for part A, the free portion of
7:38Medicare, then you can use this same
7:41application. There's a question on the
7:42application that asks you if you want
7:44part B and you'll check yes if you do
7:47and you'll check no if you don't. If you
7:49check no and complete the application,
7:51you'll be enrolled in part A only. Let's
7:53say you go ahead and enroll in Medicare
7:55Part A and B online. You're turning 65.
7:58Now what? So, what does that cover? What
8:00doesn't it cover? And what do you need
8:02to do next? That's what we'll reveal.
8:04Well, the good news is that traditional
8:06Medicare parts A and B, it covers a lot.
8:08And it allows you to see any doctor
8:11anywhere in the country that accepts
8:13Medicare. So once you're enrolled in
8:15original Medicare, you get your pick of
8:18any Medicare doctor, which most doctors
8:20take Medicare. It covers many
8:23preventative and diagnostic services,
8:25but it doesn't cover everything at 100%.
8:28So, if you just enrolled in Medicare
8:30parts A and B, traditional Medicare, and
8:33nothing else, you would have certain
8:35out-ofpocket deductibles, co-pays, and
8:38co- insurance amounts that you would be
8:40responsible for. So, let's break down
8:42how that works. When it comes to
8:43Medicare Part A, there is an inpatient
8:46hospital deductible of $1,736
8:50per benefit period. And a benefit period
8:53is 60 days. So, it's not like that's an
8:55annual hospital deductible. It is a
8:58hospital deductible that resets every 60
9:01days. Additionally, Part A has co-
9:04insurance that you're responsible for if
9:06you have an extended hospital stay. In
9:082026, you have to pay $434
9:12per day for days 61 through 90 if you
9:16had a long hospital stay. If you're in
9:18the hospital past 90 days and you have
9:20to use your lifetime reserve days, you
9:23get 50 of those and you have to pay $858
9:27per day if you are in the hospital for
9:30an extended stay using your lifetime
9:32reserve days. Additionally, Medicare
9:34Part A covers your first 20 days in a
9:36skilled nursing facility. But if you
9:38have an extended stay in a skilled
9:40nursing facility, then you have to pay
9:42$217
9:43per day for days 21 through 100. And
9:47that's just for part A. When it comes to
9:48part B, which part B covers doctor's
9:52office visits, diagnostic testing,
9:54outpatient services, ambulance services,
9:58durable medical equipment, a whole slew
10:01of services are covered by Medicare Part
10:03B. Aside from routine preventative care,
10:06which Medicare PartB typically covers in
10:08full, you do have an annual deductible
10:12that you have to pay for any type of
10:14Part B covered medical service. And this
10:16year that deductible is $283
10:19per year. So that means you have to pay
10:21the first $283
10:23of your doctor outpatient medical
10:25expenses. And then after that, Medicare
10:28pays 80% and you have to pay the other
10:3120% of your other part B covered medical
10:34services. 8020 is okay, but there's no
10:38cap on that 20%. So if you had something
10:42very expensive like let's say
10:44chemotherapy or an expensive outpatient
10:48cost you would have to pay 20% of the
10:50cost of that and there's no cap or limit
10:53on that 20%. So for seniors on a fixed
10:56income a lot of these out-ofpocket
10:59co-pays and co- insurance and
11:01deductibles could be very detrimental.
11:04And for this reason, most people on
11:06Medicare will want to look at some type
11:09of gap or alternative insurance coverage
11:13to help cap their out-ofpocket exposure
11:16in retirement. So, from there, that's
11:18where we're going to touch upon Medicare
11:19Part C and Medicare Part D. We're also
11:22going to review Metagap, also known as
11:25Medicare supplement insurance plans.
11:27We'll talk a little bit about how all of
11:29these plans work when it comes to your
11:31Medicare coverage. So, I'm up here now
11:33with my whiteboard. And we're going to
11:35dive into talking about part C and part
11:37D. Part C is Medicare Advantage. This is
11:40an optional part of Medicare. And then
11:42part D is your prescription drug
11:45coverage. So Medicare Part C, Medicare
11:48Advantage plans are optional ways to
11:51receive your Medicare benefits. They
11:54usually include the benefits of
11:56hospital, medical, and often part D
12:00prescription drug coverage all rolled
12:02into one plan. Medicare Advantage plans
12:05sometimes even include extra benefits,
12:08things that aren't generally covered by
12:10regular Medicare. Things like dental,
12:13vision, or hearing coverage is often
12:15times included in a Medicare Advantage
12:18plan as well. For many people, these
12:20will be similar to types of insurance
12:23they may have had before they went on to
12:25Medicare, like an HMO or a PO plan.
12:30These are managed care plans that use a
12:33set network of doctors in hospitals.
12:36These plans come with their own co-pays
12:39and co- insurance that they establish
12:42for certain services. So, for example,
12:44you might pay a $50 co-pay for a
12:47doctor's office visit or a $200 co-pay
12:50if you go get x-rays. There are
12:53thousands of different Medicare
12:54Advantage plans available nationwide.
12:56And the plans that you're eligible for
12:58will be based on where you live. So, in
13:01order to enroll in a Medicare Advantage
13:03plan, you do have to be enrolled in
13:05Medicare parts A and B. But once you
13:07enroll in the Medicare Advantage plan,
13:09it kind of replaces your traditional
13:12Medicare benefits. Now, instead of
13:15showing your red, white, and blue
13:16traditional Medicare card at the doctor
13:18and hospital, if you have a Medicare
13:21Advantage Part C plan, you are now
13:23showing your Part C plans card at the
13:26doctor and hospital. And your medical
13:29provider bills your part C insurance
13:33plan instead of billing traditional
13:36Medicare. So, I want to talk a little
13:37bit more about Medicare Advantage plans
13:39and how they compare to traditional
13:41Medicare because this is the biggest
13:44choice that most people will have to
13:45make when they go on to Medicare is
13:47whether or not to choose one of these
13:49part C advantage plans or not. So, I
13:52really want to go over the pros and cons
13:54and how these two compare. So, I'm going
13:56to erase this real quick. All right. So,
13:57most people on Medicare are going to
14:00have to decide whether to go with
14:02traditional Medicare and possibly add on
14:05a metagap, also known as a Medicare
14:07supplement plan, or whether to choose a
14:10part C Medicare Advantage plan. And some
14:13people make this choice without even
14:15realizing or understanding the
14:17consequences of their decision. And
14:19that's what I want to explain to you
14:20today. But first, we're going to break
14:21down the costs and how these two plans
14:23work. What makes them different and how
14:26to determine which option might be best
14:28for you. We already know that if you're
14:31enrolled in original Medicare, Part A is
14:34free, but part B costs $22.90
14:38a month for most people. Of course, that
14:42could be subject to income related
14:44monthly adjusted amounts. Now, if you
14:46enroll in Medicare Part C, a Medicare
14:48Advantage plan, you also still have to
14:50pay that $22.90
14:53per month premium for your Medicare Part
14:56B. Now, from here, if you choose to stay
14:58with original Medicare, also known as
15:00traditional Medicare, you likely need to
15:02enroll in a Part D standalone
15:06prescription drug plan to cover your
15:09prescription medications. Medicare
15:11doesn't require you to enroll in a Part
15:13D drug plan, but if you don't enroll in
15:15one when you're first eligible, and you
15:17do want to enroll in one later on down
15:19the road, you will get hit with late
15:22enrollment penalties. There are many
15:24different Part D prescription drug plans
15:26available to you, and the best one for
15:28you will be based off of which
15:30medications you really need coverage
15:32for. Medicare Part D drug plans can be
15:34as low as $0 a month or as high as $100
15:40or more a month. But for the purposes of
15:43this cost comparison, let's just say $25
15:46a month is an average Part D
15:49prescription drug plan premium. If you
15:51remember what we talked about before,
15:53traditional Medicare does come with a
15:55lot of outofpocket exposure as far as
15:59hospital deductibles, co- insurance,
16:02co-pays, etc. So, most people will want
16:05to choose a metagap, also known as a
16:07Medicare supplement plan. And a Medicare
16:10supplement plan can be a great option
16:12for many because these plans allow you
16:14to continue to choose your own doctors
16:16and hospitals. They have no network, so
16:18you can still go to any doctor in the US
16:21that accepts Medicare. And they pay all
16:24or most of the gaps in traditional
16:27Medicare. So, you're left with very
16:29little to no out-ofpocket exposure. If
16:33you do have a hospital stay, a chronic
16:35health condition, etc. Medicare
16:37supplement plans can vary, and I have
16:39other videos that I've linked below that
16:41really go into depth about which
16:42Medicare supplement plans are the best
16:45and how they work. But for today's
16:47purposes, I'm just going to say that an
16:50average Medicare supplement plan might
16:52cost you about $125
16:54a month for a plan G or plan N, which
16:57are the two most popular plans,
16:59depending on where you live. Of course,
17:01some people are going to say, "No, my
17:02premium's lower than that. My premium is
17:04much higher than that." We're just
17:06plugging this in as kind of an average
17:08national cost right now. So, when we add
17:10this all together as far as monthly
17:13premium costs, this gives us an all-in
17:15monthly premium cost of about $353
17:19a month. And what we're getting for this
17:21is really the freedom to choose any
17:24doctor or hospital we want, as well as
17:27have very little to no outofpocket costs
17:30when it comes to going to the doctor and
17:33hospitals. Now, what you're not getting
17:35here is coverage for extra benefits that
17:38are not covered by traditional Medicare.
17:40So, things like dental, vision, hearing
17:43coverage, typically not covered by
17:45original Medicare and not covered by
17:48metagap. So, the metagap is this premium
17:51right here. However, you may want to add
17:54on an extra monthly premium of maybe $30
17:58to $50 a month if you want to include
18:01dental and vision coverage as well. So,
18:03let's jump over to Medicare Part C
18:05Medicare Advantage. Part C Advantage
18:07plans, you still have to pay your Part B
18:09premium to be enrolled in them, but in
18:11most parts of the country, Medicare
18:13Advantage plans are $0 a month. Now,
18:17sometimes they can be more than that,
18:18but in most areas, you can find many
18:21Medicare Advantage plans as low as $0 a
18:24month. And these Medicare Advantage
18:26plans typically include Part D
18:28prescription drug coverage. And they
18:30often include dental and vision coverage
18:32as well and maybe even some extra
18:35benefits like transportation benefits.
18:37It can vary a lot depending on the plan.
18:39So here our monthly all-in cost is
18:41really just the $22.90
18:44per month. The catch here is that now we
18:47are on a networkmanaged care plan. So we
18:50can't necessarily just choose our own
18:52doctors and hospitals. We may need to
18:54stay in a certain network. We may need
18:57referrals if we want to go see a
18:59specialist. And we will have
19:01out-ofpocket costs that we will have to
19:03pay when we go to the doctor and
19:05hospital. So you will have co-pays and
19:07co- insurance which are established by
19:10the Medicare Advantage plan and can vary
19:13from plan to plan and they can also
19:15change every year. Medicare Advantage
19:17plans do all have a max out ofpocket,
19:20also known as a MO, right? max out of
19:23pocket limit. This means that this is
19:25the total amount that you may have to
19:28pay in co-pays, deductibles, co-
19:31insurance before your advantage plan
19:33will kick in and pay 100%. And this
19:36maximum out-ofpocket limit is also
19:38something that can vary a lot from one
19:40plan to another. Now, the maximum
19:42out-ofpocket limit that Medicare
19:44Advantage plans can have in 2026 is
19:48$9,250
19:50per year. But on most plans, it's much
19:54lower than that. On most Medicare
19:55Advantage plans, you see out-ofpocket
19:57maximum limits falling more between
20:00$4,000 to $7,000 per year. So, when it
20:04comes to comparing costs on these two
20:06plans, really, there's this gray area of
20:08the max out of pocket and how you're
20:11going to use the plan. So, if you're
20:13someone that uses a lot of medical
20:15services, you may benefit by going with
20:18something like this that has a higher
20:19monthly premium cost but much lower
20:22out-ofpocket exposure. Whereas, if
20:24you're someone that's really healthy and
20:25you rarely go to the doctor in hospital,
20:28you could benefit from having the lower
20:30monthly premium cost if it's very
20:32unlikely that you would satisfy or get
20:34close to your maximum out of pocket. So,
20:36when you look at it this way, a lot of
20:37people say, "Well, I'm really healthy
20:39right now. Maybe I'll just start off
20:41with a Medicare Advantage plan and then
20:43down the road if I need to go to
20:45traditional Medicare and add on a metag
20:47gap or Medicare supplement plan, maybe I
20:49will. But there's a big catch there. So,
20:53you cannot always switch back and forth
20:57between these two options, and I'm going
20:59to talk more about that in a minute. So,
21:02the choice you make when you are new to
21:04Medicare may stick with you for life,
21:08and I'll explain why. So, when it comes
21:10to deciding between Medicare Part C,
21:12Medicare Advantage, and going with
21:14traditional Medicare and adding on a
21:16Medicare supplement plan, this is the
21:18one thing that I hear people say to me,
21:20I wish I knew this when I was first
21:24going onto Medicare. And that has to do
21:27with Medicare supplement plan open
21:29enrollment periods. So many people
21:32falsely assume that all Medicare
21:35supplement plans have an annual open
21:38enrollment period where you can jump on
21:40over to a Medicare supplement plan and
21:42and get approved for the plan that you
21:44choose. And that is just not how it
21:46works. In most states in the country,
21:48most people get just one Medicare
21:51supplement open enrollment period. So
21:53you only get one window. It doesn't
21:55repeat annually. It's just one. And it's
21:58based on your Medicare PartB effective
22:01date. So the date that you enroll in
22:04Medicare Part B, you have up to 6 months
22:07after that Part B effective date to
22:10enroll in a Medicare supplement plan
22:13without any medical underwriting. And
22:15what most people don't realize is once
22:17that six-month window closes, the
22:20insurance companies can make you go
22:22through medical underwriting to get a
22:24plan. That means they can ask you a list
22:25of health questions on the application.
22:27You have to disclose your medications.
22:30They look at your health history in a
22:32publicly available medical database and
22:34they can choose whether to approve or
22:36deny your application for coverage. So,
22:39it's not guaranteed that you'll be
22:42medically eligible to get a plan if
22:44you're not new to Medicare. That's why
22:46the strategy of young and healthy
22:48starting with a Medicare Advantage plan
22:50and then later on when you get sick
22:52getting the Medicare supplement plan
22:54doesn't always work because if you do
22:56have a health condition or an upcoming
22:59surgery or procedure, you're typically
23:02ineligible in medical underwriting to
23:04get a Medicare supplement plan. Medicare
23:07Advantage plans, on the other hand, are
23:09not medically underwritten. Anyone can
23:11get a Medicare Advantage plan. If you're
23:13on Medicare, you can get a Medicare
23:15Advantage plan every year. There's a
23:17fall open enrollment period. So, if you
23:19start with a Medicare supplement plan,
23:22you can always later on go to an
23:23advantage plan. But if you start with an
23:26advantage plan, you cannot always later
23:28on go to a Medicare supplement plan.
23:31Now, of course, these rules can vary
23:33from stateto state, but in most states,
23:36that is how it works. When it comes to
23:38the four main parts of Medicare, the
23:40decisions that you make when you are new
23:42to Medicare really can impact your
23:45health and your wallet into retirement.
23:48So, it's really, really important to get
23:51educated, understand what your options
23:54are, and hopefully this video helped you
23:55with that today. Try to simplify things
23:58in a way that makes them easy to
24:00understand and digest. Medicare is kind
24:03of confusing by design. the I mean it's
24:06the government. They definitely don't
24:07make it simple, but my team and I are
24:10here to help. We are licensed
24:11independent insurance brokers. We work
24:13with over 30 different insurance
24:15companies. We help people with Medicare
24:18Advantage plans, Medicare supplement
24:19plans, and we really aim to offer an
24:22unbiased service in helping you choose
24:24the best Medicare plan for your needs.
24:27Best of all, our service is completely
24:29free of charge. So, you can feel free to
24:32call or email us. We would be happy to
24:34help. Many people find us right here
24:36online. Uh we are not huge call center.
24:39It's really a team of myself and agents
24:41that I work really closely with that
24:43would love the opportunity to help. So,
24:45thank you for watching today. Please
24:48leave any questions you have for me in
24:49the comment section below. I love to
24:51hear what you have to say. I try to
24:52reply to as many as I can. Thanks again
24:54for being here and we'll see you

About this transcript

This page contains the full transcript of Medicare Parts A B C D Explained - Everything you need to know! by Medicare Specialist - Abt Insurance Agency, generated from the public captions YouTube serves with the video. The transcript has 4,250 words across 618 segments, with the original timestamps preserved so you can click any line to jump to that moment in the embedded player.

What you can do with it

Use the transcript to take notes, quote the speaker, build a study guide, generate a summary with ChatGPT or Claude via the YouTube Summary tool, or export it as a timed subtitle file with YouTube to SRT. You can also re-open it in the transcriber to translate the transcript into 100+ languages.

Free YouTube transcript tool

YouTube2Text is a free YouTube transcript generator — no signup, no daily limit. Paste any YouTube link and get the full transcript instantly, with timestamps, click-to-jump, translation to 100+ languages, AI prompts for ChatGPT, Claude, and Gemini, and exports to TXT, SRT, VTT, or Markdown.