Medicare is a federal healthcare program for people aged 65 years old or older. It covers health insurance costs and is often the primary source of medical coverage. It consists of 4 parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage Plans), and Part D (prescription drug coverage). This article will discuss, in-depth, the four parts.
Part A
Part A is hospital insurance which pays for inpatient hospital care, skilled nursing facility care, and certain home health care costs. The federal government fully pays insurance premiums for Part A for those who have worked and paid Social Security taxes for at least 40 quarters. Here is what Part A cover;
1) Inpatient hospital care:
Part A covers inpatient care at hospitals and other healthcare facilities.
2) Skilled Nursing Facility Care:
Part A also covers short-term stays in a skilled nursing facility (nursing home) for rest, rehabilitation, and other medical treatments. A nursing facility is an institution that cares for patients who need medical attention daily but cannot be cared for in a hospital.
3) Home Health Care:
Part A covers home health care services, including care by a visiting nurse who will provide various health services to help people remain in their homes. These services include skilled nursing, physical therapy, occupational therapy, speech-language pathology, medical social services, and rehabilitation teaching. No one is turned away from receiving home health care based on an inability to pay. Part A will pay for all or part of home health care costs if you have been approved for Medicare benefits and meet certain conditions.
4) Hospice Care:
Part A covers hospice care, which is a form of palliative care. Hospice is medical care used to treat a person with a life-threatening illness or disease or to provide comfort and pain relief as the end of life approaches. It includes unlimited visits by trained professionals as well as unlimited phone calls and live-to-tape television viewing.
Part B
Part B is a medical insurance policy and covers the cost of outpatient hospital services, physician visits, and other medical care. The individual pays their premiums through monthly installments with Medicare taxes deducted from their paycheck by their employer during their working years and are automatically deducted from Social Security checks. Below we will discuss Part B in detail;
1) Outpatient hospital services:
Part B helps pay for diagnostic and therapeutic procedures and hospital stays (for example, surgery, chemotherapy, and certain heart procedures). It also covers home health visits and skilled nursing care.
2) Physician services:
Part B covers medically necessary services by physicians and other health professionals under contract with Medicare (such as nurse practitioners, nurse midwives, clinical psychologists, clinical social workers, physical therapists, and medically-trained therapists). These services include office visits, certain diagnostic procedures, and even home health services (including skilled nursing care).
3) Other medical items:
Part B also covers certain durable medical equipment, such as wheelchairs and oxygen equipment; brand name drugs when prescribed by a physician. Part B does not cover drugs that are in the generic form.
Part C
Part C is a Medicare Advantage Plan for those seniors who prefer this option over traditional Medicare and Part D. These plans are offered by private organizations approved by the Centers for Medicare & Medicaid Services. Here is a list of some of the major advantages;
1) Choose your own doctor/facility:
As a member of a Part C plan , you can choose any doctor or hospital in your area says Medicare specialist from Clearmatch Medicare. The same is true for prescription drugs, although most plans cap your monthly drug costs at a certain amount. You can also switch doctors or facilities and change to another plan anytime during the year.
2) Outpatient prescription drug coverage:
Many Part C plans to cover your routine medication needs. However, each plan is different, so check with the plan to see what is covered. In general, plans cover drugs ordered by doctors and administered in hospitals or doctors' offices. They may also cover other drugs that are used at home.
3) Coordinated care:
Part C plans often provide coordinated care, which means they have an agreement with other providers like physicians, hospitals, and/or pharmacies to provide services and prescription drugs to their members at a reduced cost. This is known as a "hub and spoke" model.
Part D
Part D covers the costs of approved drug regimens and a monthly prescription drug benefit. It currently covers only brand-name prescription drugs, and cost-sharing requirements differ for various categories of drugs based on the amount prescribed for each patient. The plans must be fully insured by Medicare, meaning that Part D is not optional if you want to get any benefits from this plan. Here is a list of the four types of Medigap policies offered;
1) Traditional Medigap plans:
These plans are similar to traditional Medicare and have the same benefits. However, you may have to pay higher monthly premiums than those for traditional Medicare.
2) Medicare Advantage Plans:
These plans have many of the same benefits as traditional Medicare. They may also cover pharmacy costs for seniors, who are generally not eligible for a prescription drug benefit under Part D. The plans generally charge higher premiums and/or additional cost-sharing than traditional Medicare. Still, some plan benefits may be better than those in traditional Medicare.
3) Part D Prescription Drug Plans (PDPs):
Part D prescription drug plans have a slightly different benefit structure than traditional Medicare. The various plan types are each described in greater detail below.
The first type of PDP is the traditional Medicare catastrophic coverage option, also known as the Original Medicare benefit plan or Plus Option. This basic prescription drug insurance plan covers all of Part A and most of Part B (hospital services plus preventative and other services). It does not cover benefits under Parts C or D, provided by the insurance company of your choice. However, it does cover some costs for drugs used before you turn 65 that would be covered under Parts A and B if you have them.
