Medicare Plan Benefits

Medicare Part A is one of the four parts of Original Medicare, which is the government-funded health insurance program for people who are 65 or older, as well as certain younger people with disabilities. Part A covers inpatient hospital care, hospice care, and skilled nursing facility care. It also covers some home health care and care in a religious nonmedical health care institution. This coverage is free if you or your spouse paid Medicare taxes while working. If you don’t meet the eligibility criteria, you’ll have to pay a monthly premium.

Part B covers a wide range of medically necessary services and preventative care, such as doctor visits, laboratory tests, and medical equipment. It also covers some preventive services to help maintain your health and to keep certain illnesses from getting worse. It also covers some outpatient care and preventive services, such as flu shots, and some physical and occupational therapy. Unlike Part A, Part B is not free and you will have to pay a monthly premium, most people pay the standard premium amount, however, your income may affect the amount you pay. It’s important to note that Part B does not cover long-term care, custodial care, or most prescription drugs, which are covered under Medicare Part A (hospital insurance) and Part D (drug coverage) respectively.

Medicare Part C, also known as Medicare Advantage, is an alternative to Original Medicare (Part A and Part B). Medicare Advantage plans are offered by private insurance companies and must follow rules set by Medicare. Part C plans typically include all the benefits of Original Medicare (Part A and B) and often include additional benefits such as vision, hearing, dental, and/or health and wellness programs. Some Medicare Advantage plans also include prescription drug coverage (Part D). Medicare Advantage plans may have different rules, costs, and networks of doctors and hospitals than Original Medicare. Some plans may require you to see a primary care doctor for referrals to specialists, or may have limits on certain treatments. You may also be required to pay a monthly premium, in addition to the Medicare Part B premium and any additional cost-sharing. It’s important to note that you must be enrolled in Medicare Part A and B to join a Medicare Advantage plan, and you may be required to live in a specific area or be part of a certain health care organization to enroll in a plan.

Medicare Part D is the prescription drug coverage component of Medicare. It is offered by private insurance companies and provides coverage for most prescription medications. Part D plans may have different formularies (lists of covered drugs), costs, and rules, such as prior authorization or step therapy. You can choose a stand-alone Part D plan or a Medicare Advantage plan that includes Part D coverage.