Understanding Medicare Parts A, B, C, and D

understanding medicare parts a, b, c, and d

If you’re having trouble Understanding Medicare Parts A, B, C, and D read this article aims to give you some clarification.

Understanding Medicare Parts A, B, C and D

PART A

(Inpatient Hospital Insurance)

Eligible individuals are automatically enrolled in Part A with no premium. Others apply to the program when they are eligible or pay a monthly premium if they have worked less than 40 quarters (or 10 years) in their lifetime.

Covers

  • Helps cover inpatient care in hospitals (includes critical access hospitals, inpatient rehabilitation facilities and long-term care hospitals).
  • Helps cover skilled nursing facilities (not custodial or long-term care), hospice and home healthcare services.

Does Not Cover

  • Physician services in the hospital, personal care items, private rooms (unless medically necessary), phone, television, and custodial care, such as assistance with eating, bathing, and getting dressed.

Limitations

  • There are some limitations of the number of hospital days covered for inpatient hospital coverage. Days 1-90 in a hospital stay are covered, and days 90-150 are only covered once in your lifetime. These days are called “lifetime reserve days.” Deductible and copayments apply after 150 days. Providers must accept Medicare and be accepting new patients.

PART B

(Outpatient/Physician Insurance)

To obtain Part B, an eligible individual must enroll at their Social Security office during a specific period (usually the month of your birthday and the three months before or after your birthday month).

Covers

  • Part B is voluntary and is designed to supplement Part A coverage.
  • Helps cover doctor services, outpatient care, and durable medical equipment (DME).
  • Helps cover some preventive services to help maintain a person’s health, now including an annual wellness visit.

Does Not Cover

  • Routine vision, alternative healthcare, routine hearing screening exams, preventive or restorative dental services, routine chiropractic care, prescription drugs, and first three pints of blood.

Limitations

  • Part B only covers care for eyes, teeth, or hearing when medically necessary. No coverage for custodial care, such as assistance with eating, bathing, and getting dressed. No coverage outside the United States.

PART C

(Medicare Advantage Plans)

Sometimes called an “All in One” plan, Medicare Advantage plans are a way to get Medicare benefits through private companies approved by and under contract with Medicare.

Covers

  • Includes Part A, Part B, and usually additional benefits Medicare doesn’t cover (such as fitness benefits, chiropractic care, or vision and hearing benefits).
  • Often includes Part D Coverage.
  • Benefits that go beyond Original Medicare such as out-of-pocket maximums.

Does Not Cover

  • Hospice Care (still provided by Original Medicare).
  • It’s important to review each plan carefully tosee what it does and does not cover.

Limitations

  • Coverage options vary by plan and plan type. It’s important to review options carefully.
  • Medicare Advantage plans do not have the same network as Original Medicare.

PART D

(Prescription Drug Coverage)

These are plans that help cover prescription drug costs. Plans are available through private companies that contract with Medicare to provide coverage. Each plan can vary in monthly premium and drugs covered. If an individual does not have creditable coverage (coverage equal to Original Medicare) they are subject to a penalty for each month they are not enrolled.

Covers

  • Part D is voluntary and is designed to supplement Part A and B coverage because the beneficiary pays for the coverage, while Part A and Part B have government funding.
  • All drug classes mandated by Medicare.

Does Not Cover

  • Drugs not on the Medicare formulary.
  • Certain drugs that are covered under Part B.

Limitations

  • Coverage options vary by plan and plan type. It’s important to review options carefully.

Nick Bryant is a Counselor with 10 years of experience working in community health. He enjoys concerts, mocking Dallas Cowboy fans and creating easy to understand community resources on his site HoustonCaseManagers.com. To become a more saucy social worker, hop on his free email list and receive weekly community resource guides delivered directly to your inbox.