What are the 4 Parts of Medicare?

The Medicare program was signed into law in 1965 to provide health coverage for the elderly and included Part A and Part B.

Original Medicare covered most medically necessary services and supplies in hospitals, doctors’ offices, and other health care facilities, anywhere in the U.S., that is offered by a Medicare Provider. *

Part C (Medicare Advantage plan) was enacted into law in 1997 as a more managed-care approach with an integrated benefit design, including both hospital and physician services.

The addition of Part D was enacted in 2003 and enabled Medicare Participants to join a separate Medicare approved drug coverage (Part D) plan.

Medicare generally does not cover care outside the U.S. You may be able to buy a Medicare Supplement Insurance (Medigap) plan that covers emergency care outside the U.S. There are a number of Medicare Advantage plans that offer some type of emergency and urgent care coverage while traveling.

To help pay your out-of-pocket costs under Medicare (for example your 20% coinsurance), you can also buy supplemental coverage, like Medicare Supplement Insurance (Medigap) and Medicare Advantage (Part C) plans, or have coverage from a former employer or union, or Medicaid. With either plan, beneficiaries may have cost-sharing obligations for certain services in addition to any monthly premiums they pay. This may be due as a copayment, which is a fixed dollar amount, or a coinsurance, which is a percentage of the Medicare-approved amount.

*Medicare Provider means a hospital, a CAH (Critical Access Hospital), a skilled nursing facility, a comprehensive outpatient rehabilitation facility, a home health agency, or a hospice that has in effect an agreement to participate in Medicare, or a clinic, a rehabilitation agency, or a public health agency that has in effect a similar agreement but only to furnish outpatient physical therapy or speech pathology services, or a community mental health center that has in effect a similar agreement but only to furnish partial hospitalization services.

 

Part   A (Hospital Insurance)

• Helps to cover Hospital services during inpatient stays (such as critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals)
• Inpatient care in a skilled nursing facility service for qualifying conditions (not custodial or long-term care)
• Hospice care services
• Qualifying home health care services

 

Part B (Medical Insurance)

• Helps to cover services from doctors and other health care providers
• Preventative outpatient health (like screenings, shots or vaccines, and yearly “Wellness” visits)
• Outpatient care
• Medically necessary and urgent care outpatient health services
• Emergency or medical transportation services
• Laboratory tests and other diagnostic services
• Durable medical equipment (DME) (like wheelchairs, walkers, hospital beds, and other equipment)
• Mental health inpatient and outpatient services
• Medications that must be administered by a health care professional.

 

Part C (Medicare Advantage)

• Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D and some offer additional benefits to treat specific conditions.
• Medicare Advantage plans must provide at least the same benefits as Original Medicare (aside from hospice care, which is still covered by Medicare Part A), and may offer additional benefits, such as prescription drug coverage and dental, vision and hearing coverage.

 

Part D (Drug coverage)

• Helps cover the cost of prescription drugs (including many recommended shots or vaccines).
• You obtain a Medicare drug plan in addition to Part A and/or Part B by joining a Medicare Advantage Plan with drug coverage or by purchasing a Stand-Alone Plan; both offered by private insurance companies.
• Plans that offer Medicare drug coverage are administered by private insurance companies that follow rules set by Medicare.

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