Four Parts Of Medicare

Part A, Part B, Part C and Part D

The four types or ``Parts`` of Medicare are often referred to as Parts A, B, C, and D. They include Hospital, Medical and Prescription Drug services. Below is a brief summary of each ``Part`` and what's included.

Part A = Hospital

Part A is Hospital Insurance. It is one of two parts of Original Medicare offered by the government. It covers inpatient hospital care and, limited time in a skilled nursing care facility, home healthcare services or hospice care.

Part B = Medical

Part B is Medical Insurance. It is one of two parts of Original Medicare offered by the government. It covers certain non-hospital medical expenses like doctor’s visits, screenings, blood tests, x-rays and outpatient hospital care.

Part A + Part B = Part C

More commonly known as Medicare Advantage, Part C is offered by private insurance companies. Medicare Advantage provides and coordinates Medicare Parts A & B benefits for beneficiaries and in turn, acts as a replacement for Original Medicare.

Part D = Rx Drugs

Part D is prescription drug coverage.  There are two ways for you to get prescription drug coverage, 1) through a stand-alone Prescription Drug Plan with Original Medicare or, 2) through a Medicare Advantage Prescription Drug (MAPD) plan.

and... Medicare Supplement (Medigap)

A Medicare Supplement (Medigap) policy- sold by private companies- can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs, then your Medigap policy pays its share. A Medigap policy is different from a Medicare Advantage Plan (Part C). Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.

Original Medicare vs Medicare Advantage

Differences: Costs, Benefits & Coverage

There are two ways you can receive Medicare benefits: Original Medicare and Medicare Advantage. See below for a list of some major differences between the two that are important for you to make an educated decision.

Costs

Medicare premiums, deductibles, and coinsurances (usually 20% of the Medicare-approved cost for outpatient care).

Medicare premiums and your plan’s premium, if it charges one. Your plan sets its own deductibles and copays (usually a fixed cost for each office visit). You may pay the full cost if you don’t stay in network or follow your plan’s rules.

Supplemental

You can buy a Supplemental (Medigap) policy to help pay for your out-of-pocket costs. But, only at certain times and depending on where you live.

You cannot buy a Supplemental (Medigap) policy to help pay your out-of-pocket costs along with a Medicare Advantage plan.

Drug Coverage

No. However, if you want prescription drug coverage through Original Medicare, you can buy a separate Part D plan.

Prescription Drug (Part D) coverage is included in most plans. With some exceptions, you cannot get a separate Part D plan if you have a Medicare Advantage plan.

Dental/Vision/Hearing

No. Dental, vision or hearing is not covered unless considered medically-necessary. Does not cover routine dental, vision or hearing services.

May cover some routine dental, vision and/or hearing services. All plans must at least cover the same inpatient and outpatient services of Original Medicare.

Nationwide Providers

Yes. You can go to any doctor, hospital or facility in the U.S. that accepts Original Medicare.

Usually no. If Medicare Advantage plan is an HMO, then you must stay within their network in order for the plan to cover your care. For PPO or PFFS plans, out of network care should be covered but you will pay more.

Specialist Referral

No. You do not need a referral to go see a specialist. As long as the specialist accepts Original Medicare, you can go to see them directly.

Maybe. With HMOs, you will usually need to get a referral from your Primary Care Physician. With PPOs or PFFSs, you can usually go directly to the specialist without a referral.

Out-of-Pocket Maximum

No. With Original Medicare, there is no maximum on what you could spend on health care.

Yes. Medicare Advantage plans must have an out-of-pocket limit. The plan covers the full cost of your care after you reach that limit.

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