Parts of Medicare

There are four parts of Medicare. Generally:

  • Part A is inpatient hospital stays
  • Part B is outpatient medical coverage
  • Part C (Medicare Advantage) is an alternative deal to Original Medicare
  • Part D covers prescription drugs

Medicare Part A

Medicare Part A covers the following:

  1. 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.  
  2. 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.    
  3. 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 within 14 days of receiving home care. Medicare covers up to 100 days of daily care or an unlimited amount of periodic care. 
  4. Hospice care: Medicare covers hospice care for as long as your provider deems it necessary. 

Medicare Part B

Medicare Part B covers the following:

  • 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

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Medicare Part C

Medicare Part C, aka Medicare Advantage, is a private health plan that insurance companies provide. These companies are contracted with the federal government. 

If you purchase Medicare Advantage, you will still be enrolled in Parts A and B (Original Medicare). But, Medicare Advantage plans often provide benefits that Original Medicare does not cover, including:

  • Housekeeping
  • Vision coverage
  • Dental coverage
  • Prescription drug coverage
  • Caregiver counseling and training

Medicare Part D

Medicare Part D is prescription drug coverage. It covers most outpatient prescription drugs. Private insurers offer Part D either as an independent plan or as a group of benefits contained with a Medicare Advantage plan. 

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 all 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)

Also, Part D covers most vaccines unless they are already covered under Part B. 

For any questions or for more information about Medicare coverage, call us at 830-217-6711.