Medicare is a federal program for people 65 or older – or under 65 who qualify on the basis of a disability – and you’re a U.S. citizen or legal resident who has lived in the U.S. for at least 5 consecutive years.
Understanding Medicare begins with understanding the parts of Medicare.
PART A – HOSPITAL COVERAGE helps pay for inpatient hospital stays, skilled nursing, home health, blood, and hospice.
Some things that happen in the hospital happen under Part B: ambulance services, surgeries, chemotherapy, transfusions and radiation.
PART B – OUTPATIENT MEDICAL COVERAGE helps pay for doctor visits, lab work, physical therapy, durable medical supplies.
These two parts (A,B) make up original Medicare. Original Medicare does not cover all of your medical costs. You may still need a Medicare plan that will help fill in those gaps.
PART C – MEDICARE ADVANTAGE combines Part A (hospital insurance) and Part B (medical insurance) in one plan.
Medicare Advantage is an optional form of coverage offered through private insurance. It is not part of original Medicare.
Part A and B do not cover all of the cost of your medical coverage so many beneficiaries purchased optional insurance to fill in the gaps. There are two primary options to do this. You can purchase a Medigap also known as a Supplement insurance plan or a Medicare Advantage plan.
Medicare Advantage plans are a form of managed care. You receive A and B benefits through the plan’s network of providers, instead of through original Medicare. To qualify for a Medicare Advantage plan you must be enrolled in both A and B of original Medicare and live in the plans service area.
PART D – is your prescription drug coverage it allows you to pick up your retail prescription drugs at your local pharmacy or through a mail order pharmacy. Not everyone needs Part D some people may have veterans benefits and can get some of their drugs filled at the VA; however if you don’t enroll in Part D when you’re first eligible and decide to enroll later you may be subject to a late penalty.
Medicare has four parts. Three parts cover hospital, outpatient and drug coverage and one part is another way to access your part A and B benefits.
Angela Asadi is a licensed agent specializing in Medicare Plans. You can reach her at Asadiangela@gmail.com.