Transcript (Medicare Parts at a Glance)

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Introduction

Medicare has four main parts: Part A, B, C, and D.

Each part helps cover different types of health care.

Understanding these four parts makes Medicare much easier to navigate.

Parts A and Part B together make up Original Medicare.

Part C, or Medicare Advantage, offers another way to receive Medicare benefits.

And Part D helps cover prescription drugs.

The Medicare parts include co-insurance, co-pays, and deductibles.

 

Medicare Part A

Part A is often called Medicare’s hospital insurance and

mainly covers in-patient hospital and skilled nursing facility stays.

It also covers hospice and certain home health services.

Part A also generally does not cover long-term custodial care.

Regarding hospital stays, there's a difference between Admitted and Observation. Inpatient status can significantly affect a patient's Medicare deductibles and co-pays amounts. An admitted patient would typically be covered under Medicare Part A. Observation is covered under Part B.

 

Medicare Part B

Part B is commonly referred to as medical insurance and covers outpatient services.

This includes visits with doctors and other healthcare providers.

Part B also covers many diagnostic tests, durable medical equipment, and preventive services.

Preventive services include certain screenings, vaccines, and yearly wellness visits.

Certain medications given in medical settings may also fall under Part B.

Part B commonly includes deductibles, coinsurance, or other cost sharing.

 

Medicare Part C

 Part C is better known as Medicare Advantage.

Medicare Advantage plans come from private companies approved by Medicare.

You must have Part A and B to join.

These plans offer your Part A and B benefits, with most also covering Part D prescription drugs.

Many plans offer additional benefits beyond Original Medicare. These may include dental, vision, hearing, or other services.

Advantage plans can have their own provider networks and coverage rules.

Some services or medications may require prior authorization.

Costs, networks, and additional benefits can vary between plans.

 

Medicare Part D

Part D generally covers prescription drugs you pick up at a pharmacy or receive through mail order. With Original Medicare, you can join a separate Part D plan.

Most Medicare Advantage plans include prescription drug coverage.

Each plan varies by plan rules, pharmacy network, and formulary. A formulary is a drug list covered by your Part D plan. A drug may require prior authorization, step therapy, and quantity limits. Not every medication falls under Part D. Part B often covers outpatient drugs given in medical settings. In most cases, this involves drugs given via injection or infusion, and vaccines for prevention. It is important to note that going without creditable drug coverage may also trigger a Part D late penalty. That makes prescription coverage important when first considering Medicare.

 

How the Parts Fit Together

Here is the easiest way to remember everything.

Part A is primarily hospital insurance.

Part B is primarily medical insurance.

Part C is Medicare Advantage.

And Part D provides prescription drug coverage.

But you normally do not combine all four separately.

There are two main ways to receive Medicare coverage.

With Original Medicare, you have Part A and Part B.

You can then add a separate Part D drug plan.

You may also choose Medicare Supplement Insurance, called Medigap.

The other option is Medicare Advantage, or Part C.

Medicare Advantage combines Part A and Part B benefits, and most plans also include Part D prescription coverage.

Medigap and Medicare Advantage plans cannot be combined.

 

Final Thoughts

The Medicare alphabet may seem confusing at first.

But the basic structure is actually fairly straightforward.

Understanding these pieces gives you a strong Medicare foundation.

From there, you can explore each part in greater detail.