Everyone over the age of 65 in the United States is eligible for Medicare. This federal-government-provided health insurance is also available for those suffering from kidney failure and some other disabilities. For all these individuals, Medicare parts A through D will cover a certain percentage of the charges for hospital visits, doctor visits, nursing home stays, dialysis, some medicine and supplies, and in-home health care. So that you and those you love can make the most out of the available coverage, here's a guide to help you decipher which parts of Medicare address what essential services.
Medicare Parts A and B
The first part of the Medicare alphabet soup is Part A: hospital insurance. If you or a loved one with Medicare coverage are brought into a hospital for treatment, Part A will help pay for that stay. If needed, it may also pay for a skilled nursing facility or home health care after discharge. Medicare Part A also pays for hospice care, the special services received by patients during their last six months of life.
Medicare Part B, the most comprehensive part of the program, pays for doctor visits as well as any tests the physician may order, including blood work and x-rays. Part B also pays for durable medical equipment (DME), the supplies a patient needs to take care of themself. Part B DME covers small items like slings, canes, and support stockings, as well as larger ones like wheelchairs and shower stools.
Medicare Part C
Medicare parts A and B were both part of the original 1965 Medicare system. In the 1980s, Medicare Part C was added. Also known as Medicare Advantage, Part C creates service networks such as HMOs and PPOs. Once a client signs up for an Advantage plan through Part C, the company offering the plan collects a certain amount of money from Medicare on the beneficiary's behalf to pay for hospital stays, doctor visits, and often medication. That's because Advantage Plans assume the role of Parts A and B, and also take over Medicare Part D's task of providing prescription drug benefits.
But while Medicare Advantage plans are comprehensive, they can also be complicated. Rules about what services the plan will cover, how much the insurer will pay for each service, and which doctors are in the network can change every year. Plans pay the most for doctors and facilities inside their networks. If your preferred doctor isn't in the Advantage plan's network, you'll pay higher out-of-pocket costs. You may also need to get a referral from your general doctor before seeing a specialist. Importantly, Medicare Supplement Insurance, also known as Medigap, is used by some patients to pay for high deductibles and special circumstances, and can't be used with Advantage plans. Before signing up for Medicare Part C, find out if the Advantage plan you intend to use includes doctors and facilities that are convenient and affordable for you.
Medicare Part D
Lastly, Medicare Part D offers prescription drug coverage. Part D provides a formulary, a list of medications for which Medicare will pay and how much Medicare will pay toward each drug. To stretch Medicare dollars further, clients are sometimes asked to try lower-cost medicines before similar name-brand drugs.
The practice of mailing medicine directly to the homes of Medicare clients also aims to make life easier for patients. Medical Part D (or your Advantage plan) requires your permission to do this. If you want your medicines delivered, make sure your plan is aware of your preferences and that your pharmacy has your contact information so they can get in touch with any questions or issues.
As the U.S. population ages, the role of Medicare becomes increasingly important. Medicare parts A through D represent the most medically necessary services for citizens age 65 and older -- hospital, nursing home, and hospice insurance; out-of-hospital coverage for doctors; laboratory tests and preventative treatment; and prescription drug coverage. Ask your provider if you have any questions. They'll be well-equipped to help you sift through the alphabet soup of the Medicare system.