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Medicare Parts: The ABCs (and D)
Each one of the Medicare parts provides different types of coverage. They can cover medical services and supplies that you need to maintain a healthy lifestyle, prescription medications, or when you suddenly fall ill and need help with hospitalization and skilled nursing care fees.
The Different Parts of Medicare
There are four parts to the Medicare program: Original Medicare Parts A and B, Medicare Advantage Part C, and Part D for prescription drugs. What each part covers can vary based on federal and state laws, and on private insurance company policies.
When you’re eligible for Medicare, you can enroll in Part A of the Original Medicare program that covers your hospital. You can choose to opt in Part B that covers medical expenses for service and treatment. If you choose to enroll in Part B coverage, the cost is generally taken from your Social Security benefits.
Medicare Part A is known as hospital insurance. Part A is one of two parts (along with Part B) that make up Original Medicare. It can cover necessary hospital services in the event that you need to treat a disease or illness. In general, Part A covers:
- Hospital stays
- Skilled nursing facility
- Approved home health care
Medicare Part B is known as medical insurance. It covers medically necessary services needed to diagnose or treat your medical condition, illness or disease. Part B also covers preventive services that can head off an illness or catch it early when treatment is most effective. In general, Part B covers:
- Clinical research
- Ambulance services
- Inpatient and outpatient care
- Mental health
- Getting a second opinion before surgery
- Limited outpatient prescription drugs
Medicare Part C is not a separate benefit. Also known as the Medicare Advantage Plan, it is offered by private insurance companies that are approved by Medicare. Instead of receiving your Part A and B coverage from Original Medicare, you’ll get it from your Part C plan.
Your Medicare Advantage Plan offers the same coverage as Original Medicare, excluding hospice care. Original Medicare covers this even though you’re enrolled in Part C.
However, Part C can offer more coverage than Original Medicare depending on your plan, such as:
- Health and wellness programs
- Prescription drugs
Medicare Part D helps cover the cost of prescription drugs. You can add Part D coverage through a stand-alone Prescription Drug Plan (PDP) bought from a private company or as part of your Medicare Advantage Plan.
Part D can help pay for your brand name or generic prescription drug medications. You may need to pay a monthly premium when you enroll in this plan and pay out of pocket for deductible (if applicable), copayment, and coinsurance costs.
Part D coverage costs will vary based on:
- The type of medicine
- The plan you purchase
- Whether the pharmacy is in or out of your plan’s network
- If the medicine purchased is on your plan’s formulary
- If you qualify for Extra Help (Low Income Subsidy) that helps pay your Part D costs
Pick the Plan For You
Medicare is a multi-faceted program that is meant to work with your medical needs. HealthMarkets understands the complexities of the program and can help you navigate them to find the Medicare coverage you require.