Parts of Medicare
The 5 Parts of Medicare
- Part A – inpatient hospital stays
- Part B – outpatient medical coverage
- Part C (Medicare Advantage) – an alternative to dealing with Original Medicare
- Part D – Prescription Drug Coverage
- Part E (Medicare Supplement) – an additional boost to Original Medicare
Medicare Part A
- Inpatient Hospital Care: This involves all care you receive after a physician admits you into a hospital. Medicare covers up to 90 days for each benefit period in a normal hospital. Additionally , you get 60 lifetime reserve days. Plus, it covers up to 190 lifetime days in a psychiatric hospital that is Medicare certified.
- Skilled Nursing Facility Care: Medicare covers your room and board, and some services provided in a skilled nursing facility. These include tube feedings, wound care, and medications. Medicare covers up to 100 days each benefit period. In order to qualify, you need to have spent at least three ensuing days in the hospital within 30 days of admission to a skilled nursing facility. Plus, you must have required skilled nursing or therapy services.
- Home Health Care: While Part B typically covers this, Part A coverage will ensue if you have spent at least three successive days in the hospital withing 14 days of receiving home care. Medicare covers up to 100 days of daily care of an unlimited amount of periodic care.
- Hospice Care: Medicare covers hospice care for as long as your provider deems it necessary.
Medicare Part B
- Doctor ordered x-rays and lab tests
- Provider services that are considered medically necessary
- Home health services like skilled nursing or therapy care
- Durable medical equipment that is appropriate for home use
- Emergency transportation by ambulance
- Preventative services like outpatient physical, speech, and occupational therapy
- Some prescription drugs, such as immunosuppressants and select anti-cancer drugs
Medicare Part C
Medicare Part C, also known as a Medicare Advantage plan, is a privately offered health insurance plan. The plans are offered by companies that are contracted with the federal government.
If you purchase a Medicare Advantage, you will still be enrolled in Original Medicare (Parts A and B), but, the Medicare Advantage plan often provides benefits that Original Medicare doesn’t cover including:
- Housekeeping
- Vision coverage
- Dental coverage
- Gym membership
- Over-the-Counter allocation
- Prescription coverage
- Caregiver counseling and training
Medicare Part D
Every Part D plan has a formulary, which is a list of drugs that are covered. If the drug you require is not on the formulary, you may request an exception, pay out of pocket, or submit an appeal.
The formularies vary from plan to plan, so you should request a copy. But each plan has to cover drugs in these categories:
- Antidepressants
- HIV/AIDS treatment
- Immunosuppressants
- Antipsychotic medications
- Anticonvulsive treatments for seizure disorders
- Anticancer drugs (unless they are being covered under part B)
For any questions or for more information about Medicare coverage, call us at (702) 582-5605.
Medicare Part E
Medicare Part E, also known as a Medicare Supplement plan or a Medigap plan, is a privately offered health insurance plan set to specific Medicare plan guidelines. There are several different Medicare Plan options each governed by Medicare with different coverage criteria.
If you purchase a Medicare Supplement plan, you will still be enrolled in Original Medicare (Parts A and B), and the Medicare Supplement plan will provide a higher level of health coverage with few additional benefits.
It is important to note, that if a Medicare Supplement plan is selected, a Medicare Drug plan must also be selected separately.
