Medicare Parts Explained
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All About the Four Parts of Medicare
Papers about types of medicare insurance and a stethoscope.
You don’t have to be confused about the different parts of Medicare. As the Medicare advisor our communities count on, Teton Medicare is here to clearly and concisely walk you through each part and ensure you understand exactly what your Medicare coverage is. Here are Medicare parts explained:
- Part A – inpatient hospital coverage
- Part B – outpatient medical coverage
- Part C – another health plan choice offered by private companies approved by Medicare that you may have as part of Medicare
- Part D – prescription drug coverage
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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.
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