Medicare Part A, B, C and D: What’s the Difference?

Medicare consists of four parts, each serving a different purpose. Here is a brief overview of each part and its basic features:

Part A

Part A is usually referred to as hospital insurance and covers inpatient services of hospital stays. Here are the services offered under the part:

Hospital services related to staying overnight in a hospital

A person can be treated in a skilled nursing facility (SNF) if he or she is limited or cannot perform daily functions on his or her own and/or needs nursing care for a maximum of 3 months.

Skilled Nursing Facility(SNF)

In order to receive benefits from Part A, the patient must recuperate after an extensive hospital stay that was medically necessary and not self-imposed in an SNF skilled nursing facility. Medicare must approve the place before receiving payment for these services.

Home health benefits

Home health benefits allow patients to receive medical services in their homes. Part A covers skilled nursing, physical therapy, and home health aide services administered under a physician’s direction and for which Medicare is the primary insurer.

Hospice Care

Hospice care is designed to provide comfort and relief to terminally ill patients. Part A has specific provisions for the benefit of hospice care. It covers the costs incurred for inpatient hospice services, including inpatient and outpatient hospice care.

Medical Social Services

Services provided under the medical social services part of Medicare are provided to the elderly, disabled, and persons with a mental illness. It covers doctor’s visits and care that is rendered in an inpatient or outpatient setting. This includes but is not limited to:

Medical Services Related to Unexpected Illnesses

This part covers the cost of services provided for unexpected illnesses that occur within 30 days of admission for treatment or recovery from a new illness. These are called “non-Medicare-covered acute illnesses,” that is, illnesses that require hospitalization and treatment if the person does not have health insurance coverage or other means of coverage (not including short-term or temporary coverage).

Part A is generally paid for by a portion of the Social Security taxes paid over a person’s lifetime. The amount of the Medicare tax paid is deducted from one’s Social Security benefits.

Part B

Part B covers fees for a physician, outpatient care, and outpatient hospital care if you have a Medicare-approved home health plan. This covers the cost of the services provided by your doctor, specialist, dentist, or therapist. Part B covers:

Actual Cost of Dental Services

The actual cost is determined using a process called Cost-Based Dental Examinations (CBDE).

Coverage for Preventive Services

The Plan pays 100% of the cost for some preventive services, including vaccinations, flu shots, and breast cancer screenings. This saves the patient money and can also improve their health.

Medical Equipment

The Plan covers items like walkers, wheelchairs, and hospital beds.  It also covers Hoyer lifts for people who need help getting in and out of bed. The Plan does not cover prosthetic devices or equipment like artificial teeth or eyes.  However, a separate Medicare program covers stand-alone dental plans and contact lenses. Part B is generally paid by premiums that are deducted from the Social Security check bi-weekly.

Mental health treatment

The Plan covers mental health services provided by mental health care providers. The Plan covers only certain types of mental health services such as counseling, psychotherapy, and personal care services. There are different limits on what the Plan covers for mental health treatment.

Ambulance services

The Plan covers ambulance services, including transportation to and from the hospital (ambulance fees) and emergency medical care while in transit.

Diagnostic lab tests

The Plan covers these services that are administered by a physician who works for a Medicare-approved lab. Medicare does not cover blood tests that are performed at any lab other than a Medicare-approved one. Part B is paid by monthly premiums, which are deducted from the Social Security check on a monthly basis.

Limited outpatient prescription drugs

The Plan covers these prescription drugs that are approved by Medicare only. These medicines have been determined to have a low cost relative to their efficacy and/or benefit, based on studies performed by the federal Centers for Medicare & Medicaid Services and the U.S. Department of Health and Human Services.

Part C

Part C is also referred to as Medicare Advantage. It is the Medicare supplement program, and private insurance companies provide it. It helps save potential beneficiaries money and provides the benefits they prefer.

Preventive care

The Plan covers inpatient and outpatient services that are administered in a medical facility to help prevent illness and/or injury through prevention.

Hospital Services

The Plan has lower deductibles, among other benefits like Medicare flex cards. Visit this page to learn more about these benefits.

Home Health-Services

The Plan takes over the entire cost of Medicare-covered home health services. This includes costs for inpatient and outpatient services, transportation, and rehabilitation services. For some beneficiaries, there is also home nursing care provided by nurses that the Plan contracts. The Plan covers skilled care administered in an extended stay unit (short-term) and skilled care provided in an acute hospital setting (long-term).

Ambulance Services

The Plan covers ambulance services, including transportation to and from the hospital (ambulance fees) and emergency medical care while in transit.

Prescription Drugs

The Plan covers only medications that are approved by Medicare only. These medicines have been determined to have a low cost relative to their efficacy and/or benefit, based on studies performed by the federal Centers for Medicare & Medicaid Services and the U.S. Department of Health and Human Services.

Skilled Nursing Facility Services

The Plan covers only inpatient services that are administered in a medical facility to help prevent illness and/or injury through treatment. The skilled care provided is not always nursing care but can include physical therapy and/or rehabilitation, among other things.

Part D

Part D is a program that was created as a way to help people with prescription drug coverage. The program is managed by private insurance companies that work for Medicare beneficiaries. These companies contract with pharmaceutical companies for the medical services covered by Part D. Beneficiaries pay a monthly premium deducted from their Social Security (or Railroad Retirement) check. Some beneficiaries may also have an annual deductible applied to the monthly premium payment if they choose not to use their Plan’s drug benefit as part of their prescription plan. Here are some of the items covered by Part D.

Mail-Order Pharmacies

The Plan uses mail-order pharmacies to provide prescriptions for their beneficiaries. However, this does not mean that beneficiaries cannot use local pharmacies.

Prescription Drug Coverage

The Plan provides coverage for these prescription drugs, which are approved by Medicare only. These medicines have been determined to have a low cost relative to their efficacy and/or benefit, based on studies performed by the federal Centers for Medicare & Medicaid Services and the U.S. Department of Health and Human Services.

Some of the more popular Part D prescription plans are as follows:

Continuing Coverage

These are Medicare supplemental plans that cover certain people who were formerly covered under their original Medicare plan. Some of these groups include but are not limited to individuals who have had a late enrollment penalty applied to their Social Security check and those beneficiaries who have had a previous private Medicare supplement plan terminated by the insurance company. In some cases, a beneficiary might be ineligible for Original Medicare but can qualify for an approved Part C or Part D Plan. These supplemental plans can be valuable to individuals who want additional coverage beyond their Original Medicare coverage.

Concurrent Coverage

These are Medicare supplemental plans that cover certain people who were formerly covered under their original Medicare plan. Some of these groups include but are not limited to individuals who have had a late enrollment penalty applied to their Social Security check and those beneficiaries who have had a previous private Medicare supplement plan terminated by the insurance company. In some cases, a beneficiary maybe not be eligible for Original Medicare but can qualify for an approved Part C or Part D Plan. These supplemental plans can be valuable to individuals who want additional coverage beyond their Original Medicare coverage.

Creditable Coverage

People who have had medical coverage that they pay for themselves (e.g., prior employer-sponsored, retiree, or union) may be eligible to apply that coverage toward Part A and/or Part B. Some of these groups include but are not limited to individuals who have had a late enrollment penalty applied to their Social Security check and those beneficiaries who have had a previous private Medicare supplement plan terminated by the insurance company. In some cases, a beneficiary might not be eligible for Original Medicare but can qualify for an approved Part C or Part D Plan. These supplemental plans can be valuable to individuals who want additional coverage beyond their Original Medicare coverage.

In conclusion, it is important to be aware of the different types of Medicare Supplement Plans available, which is why you should contact an agency specializing in Medicare insurance St George Utah, the eligibility requirements, and how these plans work to make an educated decision on which Plan is best for you.