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Medicare Senior Coverage-Part A-Part B-Part C

Learn about the different parts of Medicare which cover different services.

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Table of Contents Part A | Part B | Part C | Part D

Medicare has four parts:

  • Part A (Hospital Insurance) Most people do not have to pay for Part A.
  • Part B (Medical Insurance) Most people pay monthly for Part B.
  • Part C (Medicare Advantage Plans) Medicare Advantage plans are offered by private insurance companies as an alternative to Original Medicare; plans are government subsidized and regulated.
  • Part D (Prescription Drug Coverage) Part D Plans are offered by private companies to provide coverage for prescription drug costs; plans are government subsidized and regulated.

Part A: Hospital Insurance

Part A is hospital insurance that helps cover inpatient care in hospitals, skilled nursing facility, hospice, and home health care. Inpatient care in hospitals (such as critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals) You usually don’t pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working. This is called “premium-free Part A.” If you aren’t eligible for premium-free Part A, you may be able to buy Part A if you meet one of these conditions:

  • You’re 65 or older, you’re entitled to (or enrolling in) Part B, and you meet the citizenship or residency requirements.
  • You’re under 65, disabled, and your premium-free Part A coverage ended because you returned to work.

Part B: Medical Insurance

Part B helps cover medically-necessary services like doctors’ services, outpatient care, home health services, and other medical services. Part B also covers some preventive services. Check your
Medicare card
to find out if you have Part B.

How Much Does Part B Cost?

If you have Part B, you pay a Part B premium each month. Most people will pay the standard premium amount. Social Security will contact some people who have to pay more depending on their income (http://www.socialsecurity.gov/pubs/10536.html). If you don’t sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty.

How Do I Get Part B?

Some people automatically get Part B. Learn how and when you can sign up for this coverage .(http://www.medicare.gov/Publications/Pubs/pdf/11219.pdf).

What Does Part B Cover?

To find out if Part B covers something specific, visit CMS website for information on Coverage. Part B (http://www.medicare.gov/Coverage/Home.asp) covers two types of services:

  • Medically-necessary services – Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
  • Preventive services – Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

Part C: Medicare Advantage

A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.

If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).

Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non emergency or non-urgent care). These rules can change each year.

Different Types of Medicare Advantage Plans

  • Health Maintenance Organization (HMO) Plans
  • Preferred Provider Organization (PPO) Plans
  • Private Fee-for-Service (PFFS) Plans
  • Medical Savings Account (MSA) Plans

There are other less common types of Medicare Advantage Plans that may be available:

  • HMO Point of Service (HMOPOS) Plans – An HMO plan that may allow you to get some services out-of-network for a higher cost.
  • Medical Savings Account (MSA) Plans – A plan that combines a high deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year.

How Do I Get a Medicare Advantage Plan?

Not all Medicare Advantage Plans work the same way, so before you join, take the time to find and compare Medicare Health Plans in your area. Once you understand the plan’s rules and costs, you may be able to join by completing a paper application, calling the plan, or enrolling on the plans website.
Medicare also has information on quality to help you compare plans.

Part D: Medicare Prescription Drug Coverage

Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage, or you don’t get Extra Help, you’ll likely pay a late enrollment penalty.

To get the prescription drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.

2 Ways to Get Medicare Drug Coverage

There are two ways to get Medicare prescription drug coverage:

  1. Medicare Prescription Drug Plans. These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
  2. Medicare Advantage Plans (like an HMO or PPO) or other Medicare health plans that offer Medicare prescription drug coverage.
    You get all of your Part A and Part B coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.

Who Can Get Medicare Drug Coverage?

To join a Medicare Prescription Drug Plan, you must have Medicare Part A and/or Part B. To get prescription drug coverage through a Medicare Advantage Plan, you must have Part A and Part B.

How to Join a Medicare Drug Plan

Once you choose a Medicare drug plan, you may be able to join by:

  • Enrolling on the plan’s Web site or on www.medicare.gov
  • Completing a paper application
  • Calling the plan
  • Calling 1/800-MEDICARE

When you join a Medicare drug plan, you’ll give your Medicare number and the date your Part A and/or Part B coverage started. This information is on your Medicare card.

Visit the Medicare Prescription Drug Plan Finder for a list of Medicare drug plans in your area.

For more information visit www.medicare.gov or download

Medicare & You
a summary of Medicare benefits, coverage options, rights and protections, and answers to the most frequently asked questions.


http://www.medicare.gov/find-a-doctor/provider-search.aspx Medicare News group