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Parts of Medicare
Why are there so many different Medicare components? What’s the difference between Medicare parts and Medicare plans, anyway? Fortunately, we can break it down for you to help make it easier to understand. Medicare is divided into four parts, which most people unfamiliar with the program find confusing. Read on to learn more about what you need to know about the Parts of Medicare.
Your hospital insurance is covered under Medicare Part A. This can help you cover things like the cost of a semi-private room for stays, hospice, home health care, and even stays in a skilled nursing facility. Blood transfusions requiring more than 3 pints of blood are also covered under this section of Medicare. Part A is also free for most people if they have worked in the United States for at least ten years or are married to someone who has worked those quarters and is at least 62.
Part A should be viewed as your hospital room and board, as we often tell our clients. This part of Medicare provides you with a semi-private room, as well as meals and medical services while you’re in the hospital. Some people, especially those who are in good health, wonder if they only need Part A. Maybe they haven’t used many medical services yet and are wondering if they can get by with just Part A. Many things that happen in a hospital, however, fall under another part of Medicare – Part B, so unless you have other coverage that coordinates with Medicare, you should enroll in both A and B.
Outpatient services that are deemed medically necessary are covered by Medicare Part B. Doctor visits, lab testing, diagnostic imaging, preventive care, surgeries, ambulance rides, chemotherapy and radiation, and even extensive dialysis care for people with renal failure are all covered under Medicare Part B. Many of these procedures can take place in a hospital setting. However, because they are provided by physicians, they fall under Part B, making it difficult to distinguish between inpatient and outpatient care.
People occasionally ask if they really need Part B. If Medicare will be your primary or sole source of coverage, the answer is yes. The two parts of Medicare – Parts A and B combined – are now referred to as Original Medicare. You will only need to register for two parts at the Social Security office or the Railroad Retirement Board.
Part C of Medicare can be perplexing. Medicare Part C is simply another name for private Medicare insurance, unlike the other parts of Medicare, which cover specific medical benefits. Part C, now known as Medicare Advantage, was created by the Balanced Budget Act of 1997.
Medicare Advantage plans are private health insurance plans that can be used instead of traditional Medicare. Part A, Part B, and, in some cases, Part D would all be provided by the same insurance company. You will usually seek care from a network of providers if you have an advantage plan. Premiums for Part C plans are frequently lower than for Medigap plans. However, because you’ll be paying more copays as time goes on, they’re not necessarily less expensive in the long run.
Part D is a federally funded program that helps you save money on prescription drugs at the pharmacy. Unlike Parts A and B, you will not be able to enroll in Part D through the Social Security Administration. Instead, you’ll choose from a variety of Part D plans offered by private insurance companies in the Panhandle. You will have enrolled in Part D by signing up for that plan.
Optional Medicare drug plans are available. You’ll be required to pay a monthly premium to the insurance company. In exchange, you pay significantly lower copays on your medications than you would if you didn’t have Part D coverage.
Every year we get several questions about the parts of Medicare—here are some of the most common:
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What parts of Medicare will I need?
If Medicare is your only source of coverage, you will require both Parts A and B of Original Medicare. To enroll in a Medicare supplement plan or a Medicare Advantage plan, you must have both of these components. The majority of people also find themselves needing Part D. You can add this coverage on top of your Original Medicare and Medicare supplement, or you can look into Medicare Advantage plans that include a Part D drug plan. Part D is optional because some people may not need it if they have other drug coverage. -
Which parts of Medicare are mandatory?
If you didn’t have other creditable coverage, such as through a large employer, you’ll face significant penalties if you enroll late. You must enroll in both Medicare Parts A and B during your Initial Enrollment Period in order to avoid those penalties (again, unless you have other creditable coverage). While Medicare is not required by law, it is a good idea to enroll in it. You will also be automatically enrolled in Medicare Part A once you begin receiving Social Security benefits. Parts A and B are linked, so you can’t collect Social Security without Part A.
Next Steps
Our Medicare-certified agents can also go over these four parts of Medicare in greater detail to help you understand them better. If you’re interested in discussing these parts more and what will work best for you, contact us or schedule an appointment using our online booking system.