Introduction To Medicare: Exploring The Basics Of Parts A, B, C, And D
There’s no denying the fact that Medicare can be complex. Not many people understand the different parts and what each one includes, and it can be difficult for any one person to navigate their way around. In this comprehensive guide, we will break down the basics of Medicare Parts A, B, C, and D, and go in-depth about what each one covers.
What is Medicare?
Medicare is a federal health insurance program in the United States that provides coverage for millions of Americans aged 65 and older, as well as others with certain conditions. It consists of parts A, B, C & D, and it is crucial for beneficiaries to understand exactly what each one means so that they can have a comprehensive health care plan to meet their individual and specific needs.
Medicare Parts A & B
Also known as Original Medicare, Parts A & B go hand in hand. Part A primarily covers hospital stays, some health services, and hospice care. There is typically no monthly premium for those who have paid into the Medicare system through payroll taxes during their working years. Beneficiaries have the option of going to any doctor, health care provider, hospital, or facility that they choose, given that they accept new Medicare Patients and are enrolled in Medicare. Also, beneficiaries don’t have to choose a primary doctor, and in most cases, are not required to get a referral in order to see a specialist.
Part B covers basic things such as doctor visits, preventative services, medical supplies and outpatient care. The main difference is that unlike Part A, Part B does in fact require a monthly premium to be paid. However, it is comforting for many to know that this premium is based on income. Most individuals are automatically eligible for Medicare Parts A & B upon turning 65 years of age if they are receiving Social Security benefits or Railroad Retirement Board benefits.
Medicare Part C
Now we get into the basics of Medicare Part C. Also known as Medicare Advantage, Part C is an alternative way for individuals to receive benefits. These plans typically cover most of what Parts A & B cover, as well as a few additional benefits. Offered by private insurance companies for a monthly premium, these plans are approved by Medicare. Unlike Parts A & B, Medicare Advantage offers benefits such as prescription drug coverage, dental, vision, or hearing services. Also, Medicare Advantage offers beneficiaries a network of doctors and hospitals which can provide coordinated care and potentially lower out-of-pocket costs. Another advantage is that fitness or wellness benefits are often offered in order to promote a healthier lifestyle. Beneficiaries need to take into consideration that with Medicare Advantage, they are limited to specific medical providers within the plans network. It is better to understand up front exactly what this includes, so enrollees shouldn’t hesitate to contact the insurance company with any questions that they may have about their plan’s coverage.
Medicare Part D
This is a crucial component of the Medicare program. Prescription drug coverage is provided through Part D, and these plans are also offered through private insurance companies approved by Medicare. Each plan is different in terms of cost, and coverage, and the list of drugs they cover, known as formularies. For this reason, it is vital that beneficiaries review the different plans and understand what each one does and does not cover so that they can choose the best one to fit their needs.
Other factors to take into consideration are monthly premiums, deductibles, copayments or coinsurance amounts, and understanding coverage gap is equally as important.
Medigap Plans
In Original Medicare coverage, there are often holes, or “gaps” in what the plan does and does not cover. However, this doesn’t need to be a cause of concern, since there are Medigap Plans available in order to offset this. These policies that are sold by private insurance companies help to pay some of the costs that the Original Medicare Plan does not cover. Those enrolled in Original Medicare and a Medigap policy will find that each will pay its share of covered health care costs.
Those who choose to purchase a Medigap policy are typically required to have Medicare Part A and Part B. Enrollees are responsible for paying the premiums for Part B plus a premium to the Medigap insurance company.
Understanding Medicare Parts A, B, C, and D doesn’t have to be overwhelming. Each part of the program plays a different role in providing the benefits that millions of people need, and with the right information, each person can decide exactly what is right for them.
