About Medicare Parts
A, B, C and D (and Medigap)
Have you learned your A B C D's: A simple Explanation of
Medicare A B C D
This is a one-page look at Medicare for dummies
Overview
Medicare is a federal health insurance
program. It covers most people age 65 or older, some people
younger than 65 with disabilities, and people with end-stage
renal disease, often referred to as ESRD.
Medicare does not provide complete coverage
for all health care needs. Even though it pays for some
preventive services and covers most medically necessary
services, Medicare doesn't pay for many routine services like
annual physicals, or things like glasses, hearing aids, or
long term care at home or in a nursing home.
Medicare is described in "Parts", each of which refers to a
different aspect of medical or drug delivery.
Medicare Parts A, B, C and D
Medicare is divided into four parts: Part A, Part B, Part C
and Part D.
Part A: Hospital Insurance
Part A pays for most inpatient hospital care, some
inpatient skilled nursing home care, some home health care,
and hospice care. You are automatically enrolled in Part A
when you join Medicare. If you qualify automatically for
Medicare (through your own or your spouse's Social Security
record), you do not have to pay a monthly premium for Part A
coverage.
If you have 30-39 Medicare-covered employment quarters, you
may buy Part A for $216 per month (2006). If you have fewer
than 30 quarters, you may purchase Part A for $393 per month
(2006).
Part B: Medical Insurance
Part B pays for doctors' services, outpatient hospital
care, outpatient physical and speech therapy, some home health
care, ambulance services, and some medical equipment and
supplies.
Part B coverage is voluntary. The monthly premium ($96.40
in 2009) is automatically deducted from your Social Security
check every month. If you don't receive Social Security
benefits, you will be billed for Part B.
Medicare Advantage Plans, also called Medicare Part C
(combines A, B and D into an HMO or a PPO with a private
insurer)
Part C governs the way Medicare benefits are provided by
companies that contract with the Medicare program. Someone
with Medicare who enrolls in a Medicare Advantage plan
generally gets all of their medical services through that
plan. Health Maintenance Organizations (HMO's) and Preferred
Provider Organizations (PPOs) contract with Medicare to
provide Medicare benefits in a managed care setting, that
since
2006 includes the new Medicare Part D benefit in all but a
few HMOs. People enrolling in one of those
plans without Part D benefits would need to buy separate
coverage for that benefit.
You must pay the
Part B premium in order to qualify for a Medicare Advantage
Plan.
Your SeniorArk
editor has gone with Medicare Advantage. Mine has no initial
drug deductible, low co-pays, covers generics thru the
doughnut hole, and the coverage for hospitals and doctors has
been terrific. My provider has taken a hatchet to benefits,
and has boosted premiums for the coming year, so I am changing
to another health plan with a high initial deductible.
Many Seniors choose to remain with the
traditional Medicare A and B arrangement (80%-government / 20%
patient, and MediGap),
and then sign up for a stand-alone Part D Plan, described below.
Part D: Medicare Prescription Drug Coverage
(Stand-Alone Plans with a private insurer)
Part D offers some help with prescription drugs. The coverage is
voluntary and the monthly premium varies depending on how much
coverage you have. For a complete description of Part D, as
well as other prescription drug information see,
Charts,
Fiasco,
and the
Donut Hole
Medigap:
http://www.medicare.gov/medigap/default.asp
(Also called "supplemental
insurance") Generally, when you buy a Medigap policy you must
have Medicare Part A and Part B. You will have to pay the
monthly Medicare Part B premium. In addition, you will have to
pay a premium to the Medigap insurance company. A Medigap
policy is health insurance sold by private insurance companies
to fill the “gaps” in Original Medicare Plan coverage. Medigap
policies help pay some of the health care costs that the
Original Medicare Plan doesn’t cover. If you are in the
Original Medicare Plan and have a Medigap policy, then
Medicare and your Medigap policy will pay both their shares of
covered health care costs.
These Medigap
policies can be costly, but useful policies, and can be
avoided if you use a Medicare Advantage Plan (above).
Also see:
Our Main Medicare Information Page,
Social Security
Tips,
Medicare Twilight Zone
Survive a Fall into the Doughnut Hole
Part D: Does it Make Sense for Me?? |
