Currently, the Medicare Program is made up of 4 basic parts: A, B, C and D. Each part helps pay for certain healthcare services. And each of these parts also has certain costs associated with them that you may have to pay. Think of these parts as building blocks to your healthcare coverage. Parts A and B are considered Original Medicare and they are provided by the federal government. Parts C and D came later and are provided by private health insurance companies. But at any given time you will only be using either Part A, Part B, and Part D OR you will be using Part C. Let me break down what each of these are below:
Original Medicare Program
The Original Medicare Program is made up of 2 Parts. Parts A and Part B
MEDICARE PART A:
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Most of the time Part A doesn't cost you anything in terms of monthly premium as long as you have paid 40 quarters in the the Medicare system through you taxes while you were working.
If you do end up needing to use your beneifts, there is a large deductible that needs to be met before Part A starts paying benefits, but then you will be covered for the 1st 60 days after before you start to realize copays and coinsurance.
MEDICARE PART B:
Medicare Part B is outpatient medical coverage. Part B helps pay for medically necessary services performed on an outpatient basis that are needed to diagnose and treat a medical condition.
Visits to your Primary Care Physician, Specialists, Surgeries, lab work, and preventative services are all covered under Part B. There is a monthly premium that you would be responsible for that will be withdrawn directly from your Social Security check if you are drawing Social Security. Otherwise you would need to pay the premium 3 months at a time from your checking account.
There is a once a year deductible that you would have to meet before Part B pays anything, then it is a 80/20 split where you would be responsible for 20% of the costs of service.
MEDICARE PART C:
Medicare Part C is also called Medicare Advantage (MA or MAPD). It’s an alternative to Original Medicare. Medicare Advantage may include prescription drug coverage, along with other extra benefits. It is offered through private insurance companies, so you don’t enroll in it at the Social Security office or website. These are usually network plans such as HMO's and PPO's with copayments and coinsurance found all throughout the plan based on services rendered. If you have an MA plan then this becomes your Primary Insurance and Original Medicare gets set aside but you will still need to continue paying your Part B premiums.
MEDICARE PART D:
Medicare Part D is your prescription drug coverage. Part D coverage is available as a Stand Alone Option (PDP) or as part of a Medicare Advantage plan (Part C). Part D plans are offered by private insurance companies contracted and approved by Medicare and it is mandatory that you have credible drug coverage when you join Original Medicare or if you choose a Medicare Advantage plan.
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*We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1800Medicare to get information on all of your options.
*While the Center for Medicare and Medicaid Services (CMS) is requiring us to add this disclaimer, please note that we will discuss all plans available in your area, helping you choose the most appropriate plan to fit your needs.