|Medicare is a federal health insurance program for individuals who are age 65 and older, as well as for qualifying persons who have certain types of disabilities.|
Medicare provides coverage regardless of a person’s income or assets, although higher-income beneficiaries can pay more for Medicare.
You may have heard about the four parts of Medicare. However, in reality, there are three essential parts of coverage. Here’s a look at those parts, what they cover, who qualifies, and an overview of the costs.
Part A, Hospital Insurance
|Think of this as the inpatient part of Medicare. Part A has four|
» Inpatient hospital care:
This includes a semi-private room, meals, general nursing, hospital services, supplies, and medications. This care can be in acute care, critical access, and long-term care hospitals, and inpatient rehabilitation facilities. Medicare will cover the care if the physician’s order specifies two or more midnights in an inpatient facility are medically necessary. The hospital must also accept Medicare.
» Skilled nursing facility (SNF) care:
The beneficiary must need skilled nursing or therapy on a daily basis. This care is generally for rehabilitation or treatment of complex medical conditions. Medicare doesn’t cover custodial or long-term stays in a nursing home. Medicare requires a three day stay as a hospital inpatient prior to the SNF stay.
» Home health care:
Medicare has several criteria for coverage of homecare services. The beneficiary must be homebound and need skilled nursing or therapy. Once a person has qualified for home health care, Medicare will also cover medical social services, some home health aide care, supplies, and equipment.
This is end-of-life care for the terminally ill who have a life expectancy of six months or less.
Part B, Medical Insurance
This is the outpatient part of Medicare with two important pieces.
» Services to diagnose and treat a medical condition:
These include physician visits, laboratory texts, x-rays and
imaging services, durable medical equipment, and supplies.
» Preventive services:
Part B covers flu and pneumonia vaccinations, mammograms, colonoscopies, prostate exams, and more. Many services are free.
Part D, Prescription Drug Coverage
Part D is drug coverage provided by private insurance companies. Here are some important points to know about this part of Medicare.
» Medicare does not cover over the-counter (OTC) medications that one can purchase without a doctor’s prescription.
» Each drug plan establishes its own formulary (list of medications the plan covers).
WHEN TO ENROLL IN MEDICARE
|Sign-up for Medicare during your Initial Enrollment Period, which begins three months before and ends three months after the month of your 65th birthday. Enroll during the first three months and coverage will begin the first day of the birth month. Enroll in the last four months aNd coverage will be delayed, but without penalties. Miss this period and your next chance to enroll will be January 1-March 31|
|Q: This issue of Medicare Milestones discusses three parts of Medicare, but everyone knows there are four parts. What happened to Part C?|
— Jean G.
A: Hi Jean,
Medicare teaches there are four parts – A, B, C, and D. However, in reality, there are only the three parts, hospital insurance, medical insurance, and prescription drug coverage. These three parts then go together to form two paths: Original Medicare and Medicare Advantage, also known as Part C. Part C is really a combination of the three parts. A Medicare Advantage plan must provide Part A and Part B services. Many plans also provide prescription drug coverage (Part D) and are called MA-PD plans(Medicare Advantage plan with prescription drug coverage).