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Your Guide to Understanding Medicare Parts A-D

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Your Guide to Understanding Medicare Parts A-D

Thursday, July 13, 2017 8:15 AM

Medicare is a federal health insurance program for people age 65 or older, people with certain disabilities, or people with End-Stage Renal Disease (ESRD). Some people get Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) automatically, while others have to sign up for it and manually enroll during their Initial Enrollment Period (IEP).

You may choose to get your benefits through?Original Medicare, the federal program that administers Part A and Part B, or through a private insurance plan approved by Medicare to provide your benefits known as Medicare Part C (Medicare Advantage).

Original Medicare helps cover many costs, but it doesn't cover everything. If you need help paying the out-of-pocket expenses you’re responsible for, you may choose to purchase a Medicare Supplement (Medigap) policy. There are several standardized options available, including Plans A, B, C, D, F, G, K, L, M, and N. Even though these plans must adhere to federal and state regulations, they can vary in costs and benefits. When you are first eligible for Medicare, you will have a six-month Medigap enrollment period during which you'll have a guaranteed issue right to purchase any policy sold in your state. After that initial enrollment period ends, you can be subject to medical underwriting and can be turned down or charged more for a Medigap policy.

Many individuals with Part A and Part B find they need prescription drug coverage to help cover the costs of medications they need to improve or maintain their health. Prescriptions are not covered by Part A or Part B, or by supplemental health insurance (Medigap). If you have Original Medicare, you may want to consider enrolling in a stand-alone Prescription Drug Plan (PDP). If you are considering getting your benefits through a Medicare Advantage plan, you will find that many MA plans offer prescription drug coverage within their benefits.

Medicare Has Four Parts:

  1. Medicare Part A - Hospital Insurance
    Helps cover inpatient care in a hospital or skilled nursing facility (following a hospital stay), home health care services, and hospice care services. Copayments, coinsurance, and deductibles may apply for each service. You usually do not pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working.
  2. Medicare Part B - Medical Insurance
    Helps cover doctors' services, outpatient care, home health services, and other medical services. Part B also covers some preventive services. Copayments, coinsurance, and deductibles may apply for each service. You can find out if you have Part B by looking at your Medicare card. You pay the Part B premium each month. Part A and Part B are often referred to as “Original Medicare.”
  3. Medicare Part C - Medicare Advantage
    A health coverage option run by private insurance companies approved by and under contract with Medicare. Includes Part A, Part B benefits, and usually, additional coverage, such as prescription drug coverage, vision and dental care, hearing exams, and/or health and wellness programs. In addition to your Part B premium, you usually pay one monthly premium for the services provided.
  4. Medicare Part D - Medicare Prescription Drug Coverage
    A prescription drug insurance option run by private companies approved by and under contract with Medicare. Helps cover the cost of prescription drugs, may help lower your prescription drug costs, and help protect against higher costs in the future. Part D is available to everyone with Medicare.

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Last Revised 11/15/2017