You must be confused with the different parts of Medicare. Understanding each plan is easy once you know the key points and benefits covered. In this article, we will break down the differences between Medicare Part A, B, C, and D so you can choose which plan suits your medical needs.
What is Medicare?
Medicare is a US federal health insurance program for people over 65 years of age or younger individuals with End-Stage Renal Disease. There is no dollar limit on Medicare as long as the services requested are medically necessary, except for a few individual Medicare benefits.
What Are the 4 Parts of Medicare?
Medicare has four parts: A, B, C, and D.
Medicare Part A covers inpatient hospital stays while Medicare Part B covers doctor visits. Medicare Part C or Medicare Advantage plan is bought from private companies approved by Medicare, while Medicare Part D covers vaccines and prescription drugs.
Here’s a more specific overview of what each plan covers and the requirements you’ll need to enroll.
What Does Each Part of Medicare Cover?
Medicare Part A
Medicare Part A is also known as Hospital Coverage. In summary, it covers the following:
- Inpatient care in a hospital
- Skilled nursing facility care
- Nursing home care (not custodial or long-term)
- Hospice care
- Home health care
There are two types of Medicare Part A: premium-free and premium.
Premium-free Part A
Most people get premium-free Part A for paying Medicare taxes while employed. You can get premium-free Part A at 65 years old if:
- You have retirement benefits from Social Security or the Railroad Retirement Board.
- You’re eligible for Social Security or Railroad Retirement benefits even if you haven’t filed for them yet.
- You or your spouse had Medicare-covered government employment.
Under 65 years old, you can get premium-free Part A if:
- You have at least 24 months of Social Security or Railroad Retirement Board disability benefits.
- You have End-Stage Renal Disease (ESRD)
Part A Premium
If you do not meet the qualifications above, you can buy Part A instead. The premium is $274 or $499 per month in 2022. The premium payment will depend on how long you or your spouse paid Medicare taxes.
Although to buy Part A, you’ll need to have Medicare Part B (Medical Insurance) and pay the premiums for both plans.
Medicare Part A and Part B combined is also known as Original Medicare.
To know more about Medicare Enrollment, click here.
Medicare Part B
Medicare Part B is also known as Medical Coverage and it covers the following:
- Outpatient services
- Clinical research
- Ambulance services
- Durable medical equipment (DME)
- Mental health (inpatient, outpatient, and partial hospitalization)
- Limited outpatient prescription drugs
Medicare will approve your claims if they are medically necessary and preventive services.
Medically necessary services include supplies and services needed for your diagnosis and treatment based on the accredited standards of medical practice.
Preventive services focus on health care and detecting your medical condition at an early stage.
Part B Premium
The Part B premium starts at $170.10. You may also be charged higher depending on your income.
Medicare Part C
If you are not qualified for Medicare Part A and B or Original Medicare, you can still buy a Medicare Plan from private companies. This is where Medicare Part C or Medicare Advantage Plan comes in.
Part C provides the same coverage as Original Medicare.
The monthly premium varies per Part C plan. Unlike Original Medicare, you have a choice to select which medical services you would need to be covered in the Medicare Advantage plan.
Medicare Part D
Medicare Part B may cover certain vaccines and medications depending on your medical condition, but Part D provides a much wider range of vaccines and outpatient prescription drugs.
Here are the categories of prescription drugs that Part D covers:
- HIV/AIDS treatments
- Antidepressants
- Antipsychotic medications
- Anticonvulsive treatments for seizure disorders
- Immunosuppressant drugs
- Anticancer drugs (unless covered by Part B)
Medicare Part D also has a list of covered drugs called formulary. If your prescribed drug is not on the formulary, you will have to appeal to receive an exception. You may also have to pay out-of-pocket expenses.
Aside from drugs outside of the formulary, Medicare has also excluded some drugs to follow federal law. These include drugs for weight loss or gain and over-the-counter drugs.
You can consult your physician whether your prescribed drug is covered in Part A, B, or D.
The monthly premium in Part D also varies per plan. Just like Part B, you may have to pay a higher premium depending on your income.
Takeaway
Understanding the difference between Medicare Part A, B, C, and D is easy when you look at the functions and coverage of each plan.
Medicare Part A focuses on inpatient services while Part B covers outpatient services, preventive care, and some vaccines. If you are not eligible for Part A, then you will have to purchase Part C or Medicare Advantage Plan from private companies. As for Part D, it covers the prescription drugs not covered by Part B.
The premium payment also varies among Part A, B, C, and D. Part A may be premium-free if you paid Medicare taxes while working or have Social Security or Railroad Retirement benefits. Part B, and D premiums will depend on your salary.