Parts of Medicare Explained

Understanding the Parts of Medicare

Medicare is a complex system designed to provide health coverage for eligible individuals. At Teton Medicare, we're here to help you navigate the various parts of Medicare and find the right coverage for your needs. Our expertise covers:

• Medicare Part A (Hospital Insurance)
• Medicare Part B (Medical Insurance)
• Medicare Part C (Medicare Advantage Plans)
• Medicare Part D (Prescription Drug Coverage)
• Medicare Supplement Insurance (Medigap)

Contact Teton Medicare to learn more about these options and how they can work for you.

Why Understanding Medicare Parts is Crucial

Knowing the different parts of Medicare is essential for several reasons:

• Ensures you have appropriate coverage for your health needs
• Helps avoid gaps in coverage
• Allows for better financial planning
• Enables informed decisions about supplemental coverage
• Prevents unexpected out-of-pocket expenses

Our team at Teton Medicare can guide you through each part, ensuring you understand your options and make the best choice for your healthcare needs.

Medicare Part A

• Inpatient hospital care: This includes all the care you receive after being admitted to a hospital by a physician. Medicare covers up to 90 days during each benefit period in a general hospital. Additionally, you will receive 60 lifetime reserve days. Plan A also covers up to 190 lifetime days in a Medicare-certified psychiatric hospital. 
• Skilled nursing facility care: Medicare covers your room and board, along with certain services provided in a skilled nursing facility. This includes medication, tube feedings and wound care. It covers up to 100 days within each benefit period. To qualify, you must have spent at least three consecutive days in the hospital within 30 days of admission to a nursing facility and must have needed skilled nursing or therapy services. 
• Home health care: It is normally covered by Part B, but Part A coverage will kick in if you have spent at least three consecutive days as a hospital inpatient within 14 days of receiving home care. Up to 100 days of daily home care or an unlimited amount of intermittent care are covered.
• Hospice care: Hospice care is covered for as long as your provider certifies that it is necessary.

Medicare Part B

• Provider services: Any services that are deemed medically necessary are covered under Part B.
• Durable medical equipment: This is coverage of equipment that serves a medical purpose, can withstand repeated use and appropriate for home use.
• Home health services: If you are homebound and need skilled nursing or therapy care, you are covered under Medicare Plan B.
• Ambulance services: Emergency transportation by ambulance is also covered under Plan B. Limited coverage for non-emergency transportation is available when there is no safe alternative, as long as it is medically necessary.
• Preventative services: Outpatient physical, speech and occupational therapy services are covered by Plan B, as long as they are administered by a Medicare-certified therapist.
• X-rays and lab tests: All X-rays and lab tests ordered by a doctor are covered.
• Chiropractic care: Chiropractic is only covered when medically necessary to fix subluxation of the spine.
• Some prescription drugs: Certain drugs such as immunosuppressants, select anti-cancer, select antiemetic, select dialysis and other typical drugs administered by a physician are covered by Plan B.

Medicare Part C

• Medicare Part C (also known as Medicare Advantage or MA) is a private health plan provided by medical insurance companies that are contracted with the federal government. With Part C, you will still be enrolled in Original Medicare (Part A and B). However, Medicare Advantage plans may offer certain benefits that Original Medicare doesn’t cover. This can include:
• Caregiver counseling and training
• Dental coverage
• Prescription drug coverage
• Vision coverage

Medicare Part D

• Part D covers most outpatient prescription drugs. Part D is offered through private insurance companies as a stand-alone plan or as a set of benefits included with a (Part C) Medicare Advantage plan. 
• Each Part D plan has a list of covered drugs, which is called a formulary. If the drug you need is not on the formulary, you may request an exception, pay out of pocket costs, or file an appeal. These formularies differ from plan to plan, so you should request a copy. Each plan must cover all drugs in the following categories: 
• Anticancer drugs (unless they are covered under Part B)
• Anticonvulsive treatments for seizure disorders
• Antidepressants
• Antipsychotic medications
• HIV/AIDS treatment
• Immunosuppressants
• Most vaccines are covered under Part D, unless they are already covered under Part B.

Why Choose Teton Medicare

When it comes to understanding and selecting Medicare coverage, Teton Medicare stands out for several reasons:

• 50 years of combined experience in Medicare insurance consulting
• Locally owned and serving Southeast Idaho
• Immediate response to your inquiries
• Free same-day consultations available
• National certifications for Medicare
• Licensed in 9 states for Medicare
• Se habla español
• Comprehensive services including health insurance, life insurance, and annuities

Our expertise and commitment to customer service ensure that you'll receive personalized guidance tailored to your unique situation. We're here to simplify the complex world of Medicare for you.

Contact Us

Don't navigate the complexities of Medicare alone. Teton Medicare is here to help you understand the various parts of Medicare and find the right coverage for your needs. Our experienced team is ready to provide you with personalized guidance and support. Reach out to us today to schedule your free consultation and take the first step towards comprehensive Medicare coverage that gives you peace of mind.