The Four Parts of Medicare

Original Medicare has two parts: A & B, which cover hospital (inpatient) services and medical (outpatient) services. Parts C & D were added later and provide the rules of the road for Medicare Advantage Plans and Prescription Drug Plans.

Part A covers a large portion of the cost for hospital inpatient care, skilled nursing facility care, nursing home care, hospice, and home health services. The Centers for Medicare & Medicaid Services (CMS) set the rules for when these services are covered. For Part A services you are responsible for a portion of the cost. One such cost is a per incident deductible of $1,288 covering up to 60 days of inpatient hospital care. Beyond 60 days additional co-pays apply.

Part B covers 80% of medical outpatient services after an annual deductible of $166. Medical outpatient services include: doctor visits, labs, tests, x-rays, outpatient surgery, durable medical equipment, and ambulance. The remaining 20% of medical expenses is your responsibility. There is NO LIMIT to the amount you may have to pay. Some doctors may also bill up to 15% above Medicare’s approved rates, which is also your responsibility to pay.

Original Medicare does not cover most Prescription Drugs, Vision, Dental, Hearing Aids, Private-Duty Nursing or Long-Term Care.  For a complete list of Part A & B services and associated shares of cost please visit Medicare’s website at www.medicare.gov under the What Medicare Covers tab.

Part C offers an alternative method for accessing your Medicare benefits. Medicare Advantage Plans, sometimes called Medicare Part C or MAPD, are offered by private insurance companies approved by Medicare.  You continue to pay any required premiums for Original Medicare.  However, all of your services are handled through the insurance company and the network of doctors and hospitals they contract to provide services.

Part D sets the rules of the road for all Medicare prescription drug plans. These plans are offered by private insurance companies and must meet the minimum standard set by the Centers for Medicare & Medicaid Services (CMS). Plan price varies depending on the formulary, deductible, co-pays and possible help in the coverage gap.

To learn more about Medicare eligibility and enrollment click the read more button.

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