Medicare is a federal health insurance program that provides coverage for individuals who are 65 years of age or older, or those who have certain disabilities or illnesses. The program is divided into four parts: Part A, Part B, Part C, and Part D. Each part provides coverage for different services and has its own set of rules, costs, and restrictions.
Part A, also known as hospital insurance, covers inpatient hospital stays, skilled nursing facilities, hospice care, and some home health care services. If you or your spouse paid Medicare taxes for at least 10 years, you will typically not have to pay a monthly premium for Part A. However, you may have to pay a deductible and coinsurance for each benefit period.
Part B, also known as medical insurance, covers outpatient services, such as doctor visits, preventive services, and medical equipment. You will typically have to pay a monthly premium for Part B, and you may have to pay a deductible and coinsurance for each service you receive.
Most beneficiaries choose to receive their Part A and B benefits through Original Medicare, the traditional fee-for-service program offered directly through the federal government. Under Original Medicare, you can see any doctor or hospital that accepts Medicare, and you do not need to get prior authorization from Medicare or your primary care doctor.
However, if you prefer to receive your Medicare benefits through a private insurance company, you may enroll in a Medicare Advantage Plan (Part C). Medicare Advantage Plans are required to cover all services covered by Part A and Part B, but they can do so with different rules, costs, and restrictions. For example, Medicare Advantage Plans may have network restrictions, meaning that you may be limited in your choice of doctors and hospitals. However, some plans may offer additional benefits that Original Medicare does not cover, such as dental, vision, or hearing care.
Part D, also known as prescription drug coverage, helps cover the cost of prescription drugs. You can get Part D coverage through a stand-alone Medicare private drug plan (PDP) if you have Original Medicare, or through a Medicare Advantage Plan that includes prescription drug coverage. You will typically have to pay a monthly premium, deductible, and coinsurance or copayment for each prescription drug you receive.
It is important to carefully consider your Medicare coverage options and choose the plan that best meets your needs and budget. The choices you make can affect your out-of-pocket costs and where you can receive care. Whether you choose Original Medicare or a Medicare Advantage Plan, it is important to understand the rules, costs, and restrictions of each part of Medicare.