Understanding The Different Parts Of Medicare
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Medicare Part A
Medicare Part B
Medicare Part C
Medicare Part D
Medigap
Parts Of Medicare
The Medicare program is divided into 4 parts; Parts A, B, C, and D, as well as supplemental options. Parts A and B make up “Original Medicare”, which automatically starts when you turn 65, unless you defer it. These parts can often get mixed up or confused: what are the major differences between each of the parts and which part(s) do I need?
Let us break them down for you to help you understand which part(s) applies to your needs.
Medicare Part A
Hospital Insurance
Generally, Part A covers most hospital expense such as inpatient hospital care with a semi-private room for your hospital stay, including meals and medical services while you are in the hospital.
Part A also covers some skilled nursing facility care, inpatient care in a skilled nursing facility (not custodial or long-term care), hospice care and home health care. There are a couple of ways you can determine if Part A covers what you need. You can talk to your doctor about the services or supplies you need and why you need them and ask if Medicare will cover them. Or you can go to the Medicare website to find out which services and supplies are covered.
Even if you are healthy and think you only need Part A because you may not need medical insurance right away, it is wise to enroll in both Part A and B to cover all of your bases just in case. Unless you have other coverage.
Medicare Part B
Medical Insurance
Part B provides coverage outpatient care services. Part B also cover medical supplies, preventive services and certain doctors’ services such as doctor office visits, lab testing, surgeries, ambulance rides, chemotherapy and radiation, and more.
If Medicare will be your primary form of coverage or your only coverage, then you will need Part B.
Parts A and B make up what is called Original Medicare. These are the only two parts that you will sign up for at the Railroad Retirement Board or Social Security office.
Medicare Part C
Medicare Advantage Plan
Part C is an “all in one” alternative to Medicare and is another name for private Medicare insurance. Part C does not cover specific medical expenses. However, Medicare Advantage Plans may offer prescription drug coverage that fall under the same rules as Medicare Prescription Drug Plans.
You still have Medicare when you join a Medicare Advantage plan. The only difference is that your Medicare Advantage plan covers and pays for your services instead of Original Medicare (Parts A and B). Your Medicare Advantage plan must provide the same coverage as Original Medicare so that you don’t miss out on coverage and it can also offer extra benefits.
Medicare Part D
Prescription Drug Coverage
Part D plans are optional and are part of a Medicare Advantage plan offered by private insurance companies and other private companies approved by Medicare. You will have to pay a monthly premium to the insurance carrier and in return, you will receive a significantly lower copay on your prescriptions than you would have if you didn’t have Medicare Part D. You can get Medicare prescription drug coverage through Medicare Prescription Drug Plans (PDPs) can be added onto Original Medicare, as well as some Medicare Private Fee-for-Service (PFFS) Plans, some Medicare Cost Plans, and Medicare Medical Savings Account (MSA) Plans. You can also get coverage through some Medicare Advantage Plans (such as HMOs or PPOs) or other Medicare health plans that offer prescription drug coverage. These plans are sometimes referred to as “MA-PDs.”
Medicare Supplement Plans
“Medigap” Plans A-N
Medicare Supplement, also known as Medigap, insurance plans fill the in “gaps” in basic coverage that Original Medicare won’t take care of such as deductibles, coinsurance, and copayments.
Medicare Supplement plans are standardized across the board. There are around 10 standardized Medicare Supplement insurance plans labeled A-N. The private insurance companies that offer these plans do not necessarily offer all of the plans, but they have to offer Plan A at the least.
It is important to take note of the fact that although the names of the Medicare Supplement plans are the same as the different parts of Medicare, take Part A for example. But they are not the same as Medigap Plan A.
As mentioned above, the basic benefits offered for each Medicare Supplement plan are the same from one carrier to another, the only difference is the price you pay in premiums. We have the ability shop around for the best plan to fit your needs through today’s top carriers.
How are plan premiums priced from one insurance company to another, there are a few different ways pricing is determined, community or no-age-rated premiums are the same price no matter how old you are. Issue-age-rated premiums are based on your age when you first enroll in the policy. The younger you are, the lower your premium will be. Attained-age-rated premiums are similar to issue-age-rated in that the premium is based on the age you are when you enroll in the policy. However, the premiums increase as you get older.