What are the Parts of Medicare

 

When you start to look for a Medicare plan, you will soon learn that there are different plans available to you based on what your needs are. As you decide which plan is best, keep in mind what you may need in the future.

There are four parts of Medicare.
In general:
  • Part A = inpatient hospital coverage
  • Part B = outpatient medical coverage
  • Part C = known as Medicare Advantage, available through private companies
  • Part D = prescription drug coverage

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Most of the time Part A doesn’t cost anything.

Medicare Part B is outpatient medical coverage. Part B helps pay for medically necessary services performed on an outpatient basis that are needed to diagnose and treat a medical condition.

Surgeries, lab work, and preventative services are all covered under Part B as well as certain doctors’ services, medical supplies and preventative services.

Part B covers things like:
  • Clinical research
  • Ambulance services
  • Durable medical equipment (DME)
  • Mental health
  • Inpatient Outpatient Partial hospitalization
  • Limited outpatient prescription drugs

Medicare Part C is also called Medicare Advantage (MA). It’s an alternative benefit form to Original Medicare. Medicare Advantage may include prescription drug coverage, along with other extra benefits. It is offered through private insurance companies, so you don’t enroll in it at the Social Security office or website.

Medicare Part D is also known as prescription drug coverage. Part D coverage is available as a Stand Alone Option (PDP) or as part of a Medicare Advantage plan (Part C). Part D plans are offered by private insurance companies contracted and approved by Medicare.

Part D adds prescription drug coverage to:
  • Original Medicare
  • Some Medicare Cost Plans
  • Some Medicare Private-Fee-for-Service Plans
  • Medicare Medical Savings Account Plans
Supplements

Medicare Supplement plans, also called Medigap, are designed to work with Original Medicare Parts A and B. Medigap policies help pay for some health care costs not covered by Original Medicare, such as deductibles, coinsurance and foreign travel emergency.

These plans are offered by private insurance companies and are available to people with Medicare Part A and B.

People with Original Medicare and a Medicare supplement can choose any stand-alone Part D prescription plans to pay for their drugs.

People who are enrolled in Medicare Advantage plans (Part C) are not eligible for a Medicare Supplement insurance policy.

Medicare coverage is based on 3 main factors
  • Federal and state laws.
  • National coverage decisions made by Medicare about whether something is covered.
  • Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.

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