The terms and acronyms of Medicare can be confusing and one of the most common places that trips people up are the different parts and plans.
Medicare Part A and Medicare Part B together are known as Original Medicare. Medicare Part C is most often called Medicare Advantage. These three parts make up the core components of Medicare coverage, but are different from Medigap plans.
Understanding the Different “Parts” of Medicare
Don’t get Medicare Part A confused with “Plan A” that’s marketed by Medicare Supplement Insurance providers. The names may sound similar, but the meaning and coverage is different. This is true for other parts and plans as well. In all, there are four parts that make up Medicare coverage: Part A, Part B, Part C and Part D.
What Is Medicare Part A?
Medicare Part A represents hospital coverage through the Medicare program. Medicare Part A covers:
- Common hospital-related expenses, like the cost of a semi-private room in a hospital.
- Some hospice, home healthcare, or stays in a skilled nursing facility.
- Blood transfusions in the event that you require more than 3 pints of blood in an emergency.
As long as you have worked for 10 years in the United States or are married to someone who has done so, Part A coverage is generally free. This is why most people enroll in Part A coverage as soon as they turn 65 and become eligible, because there is generally no monthly premium to go along with this coverage. Think of it as your “room and board” while in a hospital.
Of course, while Medicare Part A is responsible for hospital related coverage, it won’t necessarily cover all of the services that you may receive while in the hospital. For that reason, it’s still suggested that you sign up for both Part A and Part B coverage to stay protected.
What Is Medicare Part B?
Medicare Part B is the other half of Original Medicare. Medicare Part B helps to pay for outpatient services, like primary care. This includes your doctor office visits, lab tests, preventative care, dialogistic imaging and so on. As you can see, many of these things may take place during a hospital stay, which is why both Part A and Part B are always recommended. Together, they help to give you complete coverage.
Medicare Part B is what’s responsible for covering other medical services like your ambulance ride to the hospital or your surgeries, chemotherapy, radiation, or even extensive dialysis if you have renal failure. These procedures often occur in a hospital, but they fall under Part B coverage because they are provided by physicians.
It’s important to note that you pay a premium each month for Part B. Also, after your deductible is met, you typically pay 20% of the Medicare-approved amount for Part B services. It’s good to keep this in mind when considering original Medicare or a Medicare Advantage plan, as Medicare Advantage plans often have an out of pocket maximum. That means, on original Medicare, you would be responsible for 20% of a $5 bill or 20% of a $5 billion bill, whereas with a Medicare Advantage plan you would only be responsible for the out of pocket maximum yearly amount.
While it’s not always easy to distinguish between inpatient and outpatient care, with both Part A and Part B coverage, you should have a pretty solid foundation for receiving medical attention.
What Is Medicare Part C?
Medicare Part C is another area where some beneficiaries get a little confused. That’s because, unlike other parts of Medicare that describe specific benefits you’ll receive through the Medicare program, Medicare Part C is actually just a name for Medicare Advantage plans (private Medicare insurance).
You can choose a Medicare Advantage plan instead of Medicare coverage. Medicare Advantage plans give you Part A and Part B coverage through a private insurance policy and are legally required to offer at least the same amount of coverage as Part A and B. These policies also sometimes bundle Part D coverage into your plan. While Medicare Advantage plans are meant to simplify coverage, they aren’t always right for everyone. So, before signing up, be sure that you compare a Medicare supplement insurance policy to a Medicare Advantage plan. Also, keep in mind that you don’t have to enroll in either. For some people, Original Medicare is enough on its own.
What Is Medicare Part D?
The final part of Medicare is Medicare Part D. This program was created by the federal government to help protect people from the high costs of prescription drugs. That’s why Part D is often called prescription drug coverage.
However, unlike Medicare Part A and Part B, which you must enroll in at the Social Security office, you will sign up for optional Part D coverage from a private insurance provider in your area. Part D is not required, although many people opt for it because the relatively low monthly premium typically covers a lot of out-of-pocket prescription drug costs.
Keep in mind that there are rules regarding when you can enroll or remove yourself from a Part D plan. You may also be barred from getting Medicare Part D coverage if you already have a Medicare Supplement Insurance plan. So, if Part D coverage is important to you and you are opting for a Medigap policy, your Medigap policy needs to include prescription drug coverage bundled into the plan itself.
Also, you may have heard of the term “donut hole.” The donut hole is a coverage gap after you’ve spent a certain amount on covered prescriptions in your Part D plan. It begins once you reach a certain amount of out of pocket expenses on drugs. After you reach this number, you’re responsible for no more than 25% of the plan’s cost for name brand prescription drugs. Once the coverage gap ends, the plan will pick up the costs again.
What Is Medicare Part F?
Medicare Part F actually doesn’t exist. When people begin talking about “Part F” or “Part G,” they have likely confused Medigap Plans with the parts of the Medicare program itself. This is simply due to similar wording, with Medicare supplement insurance (Medigap) policies offering Plan A, B, C, D, F, G, K, L, M and N.
Get The Most Out of Medicare
At Iora Primary Care, we want every patient to get the most out of their Medicare coverage. As you may already know, the annual election period for Medicare patients is coming up soon. This is an opportunity to review your plan and make sure you’re still on the best one for your health needs. If you are interested in learning more or need help, click here. We can connect you with a trusted insurance representative.