Understanding Parts of Medicare

We make the process of learning about the complexities of Medicare Parts, simple and easy for you to understand.

Understanding the Different Parts of Medicare

Medicare is unique compared to other health insurance plans. Instead of a single plan that covers all your needs, Medicare is divided into several parts that together provide comprehensive coverage. It’s important to know what each part offers so you can decide which ones you need to enroll in.

Medicare Part A: Hospital Insurance

Medicare Part A, also known as hospital insurance, covers costs associated with inpatient hospital stays, care in a skilled nursing facility, some home health care services, and hospice care. Here’s a closer look at each of these services:

Inpatient Hospital Care: Covers up to 90 days of care per benefit period in a general hospital, with an additional 60 lifetime reserve days. Also covers up to 190 lifetime days in a Medicare-approved psychiatric hospital.
Skilled Nursing Facility Care: Covers up to 100 days of care per benefit period, including room, board, and specific services like medications and wound care, if you’ve spent at least three consecutive days in the hospital.
Home Health Care: Covers up to 100 days of daily care and an unlimited amount of intermittent care if you’ve spent at least three consecutive days as a hospital inpatient within 14 days of receiving home health care.
Hospice Care: Covers hospice care if your provider certifies it as necessary.

Most people don’t pay a premium for Part A if they or their spouse have paid Medicare taxes for at least ten years (40 quarters). Those who don’t meet this requirement can purchase Part A, with premiums based on the number of quarters taxes were paid.

Medicare Part B: Medical Insurance

Medicare Part B, or medical insurance, covers outpatient care, preventive services, and other health services not covered by Part A. Key services covered by Part B include:

Provider Services: Covers all medically necessary treatments provided by doctors and other health care providers.
Durable Medical Equipment (DME): Covers items like oxygen tanks, walkers, and hospital beds for home use.
Home Health Services: Covers services like physical, speech, and occupational therapy.
Ambulance Services: Covers emergency transportation and some non-emergency transit if medically necessary.
Preventive Services: Includes screenings, counseling, and vaccines to prevent or detect illnesses early.
Lab Tests and X-rays: Covers diagnostic tests and imaging.
Chiropractic Care: Limited to necessary spinal adjustments.
Certain Prescription Drugs: Covers some medications administered by a physician, such as immunosuppressants and chemotherapy drugs.

Part B has a monthly premium, an annual deductible, and generally covers 80% of the cost of covered services. Premiums may be higher for those with higher incomes, and financial assistance is available for those with limited incomes.

Medicare Part C: Medicare Advantage

Medicare Part C, or Medicare Advantage, is an alternative to Original Medicare (Parts A and B) provided by private insurance companies approved by Medicare. These plans often include additional benefits like dental, vision, hearing, wellness programs, and prescription drug coverage.

Medicare Advantage plans typically have lower premiums and may offer additional benefits, but you’ll still pay the Part B premium and any cost-sharing amounts specified by the plan. Each plan is different, so it’s important to compare options carefully.

Medicare Part D: Prescription Drug Coverage

Medicare Part D provides coverage for outpatient prescription drugs. Offered through private insurance companies, Part D plans can be stand-alone or part of a Medicare Advantage plan with drug coverage (MAPD).

Each Part D plan has a formulary, or list of covered drugs, organized into tiers. Lower tiers typically include generic medications, while higher tiers include brand-name and specialty drugs. Your costs will depend on the drug tier and whether you’ve met your deductible.

Part D plans also have four coverage phases: Deductible Phase, Initial Coverage Phase, Coverage Gap (Donut Hole), and Catastrophic Coverage. Your out-of-pocket costs will vary depending on the phase you’re in when you pick up your prescriptions.

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Getting Help with Medicare

Navigating Medicare can be complex, but you don’t have to do it alone. Bobby Brock Insurance can help you understand your options and choose the right coverage for your needs. Whether it’s Medicare Part A, B, C, or D, our team is here to guide you through the process and ensure you get the coverage you need. Call us today to get started!

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