If you are new to Medicare, the government health insurance for seniors, it can be confusing understanding the different parts to the program. Here are the differences between Medicare Parts A-B-C and D.
Medicare is a government run health insurance program for seniors. Those with disabilities can also qualify. To become eligible for Medicare, you must be at least 65, a US citizen or permanent resident and have worked, or have a spouse that has worked, for a “Medicare-covered employer” for at least ten years and have paid Medicare taxes. Enrollment is automatic at age 65 if you are receiving Social Security or, if you are not, you can enroll within seven months of turning 65. The program has four parts – Medicare A, B, C and D. Medicare Parts A & B are the “basic,” or “original” Medicare and provides basic hospital and medical insurance. With Medicare Parts A & B, you can see any doctor or specialist that accepts Medicare or visit any hospital when you need care. Typically, there is no premium for Part A and you pay a premium for Part B (although there are exceptions to this) with co-pays for each service.
Medicare A & B does not cover the prescription drugs that one would purchase at a pharmacy. If you want prescription drug coverage, you will need to enroll in Medicare Part D. Medicare Part C, often called “Medicare Advantage” is very similar to a medical insurance plan offered by an employer, operating much like an HMO or PPO, with a more limited network of doctors that you can see but offering increased coverage, especially on things such as dental and vision care. There are separate premiums and co-pays for Medicare Part C.
Medicare Part A
Medicare Part A is free for those 65 and older that have paid Medicare taxes, or have a spouse that have paid Medicare taxes, for at least ten years. Otherwise you pay a monthly premium. Medicare Part A is hospital insurance and covers:
- Emergency room care
- Inpatient hospital care for up to 60 days
- Care in a skilled nursing or rehabilitation facility for up to 100 days each benefit period
- Skilled home health care for up to 100 days (certain restrictions apply)
- Hospice care as long as necessary
What is not covered is long-term care in an assisted living, rehabilitation or memory care community. Although there are no Medicare Part A premiums for most seniors, Medicare doesn’t pay the full cost of care and there are deductibles that must be met before Medicare kicks in along with co-pays. Many seniors purchase what are called “Medigap” plans (often called “Medicare Part F”) to cover the deductibles.
Medicare Part B
Medicare Part B is medical insurance and covers services and supplies that are needed to diagnose and treat medical conditions as well as preventative care. Unlike Medicare Part A, Medicare Part B requires a monthly premium which can be taken out of your Social Security check. While Medicare Part B is optional, there are increased premium costs if you delay enrollment beyond age 65. Medicare Part B covers:
- Doctor Visits
- X-Rays, Lab Tests
- Preventative services such as health screenings
- Ambulance services
- Medical equipment such as walkers, wheelchairs and oxygen tanks
- Physical therapy services
- Chiropractic care deemed medically necessary
- Drugs administered by a medical professional such as chemotherapy
What is equally important to note is what Medicare Part B doesn’t cover:
- Most dental care
- Vision care
- Hearing aids
- Long term nursing home care
- Cosmetic surgery
- Alternative medicine including acupuncture
- Prescription drugs
Because of what is not covered by Medicare Parts A & B, many seniors opt to sign up for Medicare Part D and/or Part C, both of which are optional.
Medicare Part D
Medicare Part D covers the common prescription drugs that you would purchase at a pharmacy. However, it does not cover weight loss drugs, drugs to deal with hair growth or erectile dysfunction, common over the counter drugs and any medication covered by Medicare Parts A and B. Medicare Part D plans are purchased through private insurers. Premiums vary according to plan and where you live so it helps to shop around. With Medicare Part D plans, there are often co-pays and deductibles. While Medicare Part D is optional, there are increased premium costs for not signing up during the enrollment period for Parts A and B.
Medicare Part C
Medicare Part C, commonly referred to as “Medicare Advantage Plans,” are purchased through private insurers and operate much like HMO’s or PPO’s with a certain network or doctors and medical providers that you can see within each plan. With Medicare Part C, you choose a primary care physician who directs your care and refers you to specialists if needed. While
Medicare Advantage Plans have co-pays, deductibles and premiums in addition to the Part B premiums, they typically offer dental and vision care, eyeglasses, hearing aids and dentures, prescription drug coverage, medical equipment such as wheelchair ramps and shower grips, home health care and housekeeping and meal support in addition to the benefits offered with Medicare Parts A & B. To qualify for a Medicare Advantage Plan, you must be enrolled in Medicare Parts A & B and pay the Part B premium in addition to the Medicare Advantage premium which could run as much as $300+ per month. Because of the added costs and variety of Medicare Advantage Plans, it pays to shop around and see if Medicare Part C is right for you.
The rules governing Medicare A-B-C and D and what is and isn’t covered change frequently. If you have questions on coverage, eligibility or wish to enroll and / or shop Medicare Advantage plans, please visit the official medicare site or shop now below: