The 4 Parts of Medicare
What are the 4 parts of Medicare? What does each part do, and what parts do I need? An explanation from an agent.
When you are close to turning 65 and going on Medicare it's easy to get overwhelmed when you are getting bombarded by the wide array of information getting mailed to you, people calling you, and you start noticing all of the television advertisements related to Medicare.
We're here to help.
Medicare has 4 parts, and they are as follows:
Medicare Part A: What does Part A cover?
Hospital care: hospital services, which include, meals, nursing, semi-private rooms, drugs as part of your inpatient treatment, and hospital services and supplies. This includes Acute care, Critical access, and Long term care hospitals as well as inpatient rehabilitation facilities
Skilled Nursing Care: Medicare Part A covers Skilled nursing care in Skilled nursing facilities under certain conditions for a limited time.
Nursing home care: This is only covered if it pertains to a Skilled nursing facility. It will medically necessary for you to have skilled nursing care (for instance, like changing sterile dressings)
Hospice care: is generally given in a person’s home, but may also be administered in a hospice inpatient facility. This will depend on the type of terminal illness, and related conditions as well as the plan of care your hospice team executes.
Home health services contain certain eligible home health services such as continued occupational services, speech-language pathology services, physical therapy and intermittent skilled nursing care. These services are only covered when the services are specific and an effective treatment for the specific condition. It must also safe, completed in a timely manner. To be eligible your condition must be expected to improve in a reasonable time and in a generally predictable period, or if you need a skilled therapist to safely and effectively do the required maintenance therapy for your condition. Medicare requires the agency be certified, you must be homebound and your doctor must certify that you are indeed homebound.
Medicare Part B: What does Part B cover?
In general Part B, is medical insurance for regular doctor’s visits and testing. This includes anything that is medically necessary, such as surgeries, follow ups for surgeries. Part B covers, clinical research, ambulance services, durable medical equipment, mental health and then it also covers getting a second opinion before a surgery. It also covers part-time home health and rehabilitative services, such as physical therapy, if they are requested by your physician to treat your condition.
Medicare Part C: What is Part C?
If you are currently enrolled in part A and part B, you can choose to enroll into a Part C, or Medicare Advantage plan. These plans are offered by private insurance companies to coordinate and provide hospital and medical benefits for beneficiaries. Medicare Advantage is required to covered everything that Original Medicare covers, including emergency, and urgent care. These plans sometimes will offer additional benefits such as coverage for routine vision or dental services, dentures and more. Some Part C plans have a $0 premium, but you must continue to pay the Part B premium. These plans have strict networks that you must use, as well as co-pays and set out of pocket maximum.
Some of the different types of Medicare Advantage plans are as follows:
HMO: (Health Maintenance Organization plan): Allows you to see doctors in-network, usually with lower monthly premiums, but them member doesn’t have any coverage outside of the network for any services other than true medical emergencies.
PPO: (Preferred Provider Organization plan): These plans will allow you to see in and out of network providers, which gives you the ability to see doctor’s in the network or out of the network and still have coverage.
PFFS: (Private Fee for Service plan): The plan has a set fee it will pay when you get care, and the treating doctor must accept those terms and conditions. If the doctor will not accept the terms, the plan doesn’t cover the services.
SNP: (Special Needs Plan): This is a plan that is available for people who have certain medical needs. The three different SNP plans cover Medicare beneficiaries, who are living in institutions, those who are dual eligible for Medicare and Medicaid, as well as those with chronic conditions such as AIDS/HIV, ESRD (end-stage renal disease). These plans typically include prescription coverage as well.
Part D: What is Part D?
Part D is also called the Medicare prescription drug benefit, subsidized through the federal government to help pay the cost of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries. President George Bush, in 2003 signed the legislation that enacted Part D as part of the Medicare Modernization Act of 2003. This went into effect on January 1st, 2006.