Understanding Medicare Parts

Medicare is broken down into a variety of parts. To understand your coverage, you must understand every part and how it relates to your medical situation. Luckily, there are only four main parts to Medicare that patients have to know about.

In almost all cases, you will deal with Medicare Part A and Medicare Part B, which cover common medical services. You will also have to know about Medicare Part C and Medicare Part D. These four Parts make up Medicare.

Which Parts of Medicare Are Included in All Medicare Programs?

When people think of Medicare, they are generally thinking of Original Medicare, the federally sponsored health insurance program. Original Medicare was the only option for many decades after Medicare began.

However, there is now an alternative known as the Medicare Advantage Plan (Medicare Part C). Medicare Advantage Plans differ from Original Medicare because private corporations, not a government entity, administer them. However, these private insurance schemes meet basic coverage standards and are still overseen by Medicare.

Original Medicare will always include Medicare Part A and Part B. Medicare Advantage Plans are always required to cover at least what Original Medicare would cover, so they also must cover Part A and Part B.

"Parts" represent the kinds of treatments that may be covered. Think of them as different categories, with treatments always assigned to one category or another. The four Parts cover all possible medical treatments that you can receive benefits for.

Original Medicare Parts:

Medicare Part A

Medicare Part A (Hospital Insurance) is the part of Medicare that covers treatments from a medical doctor at a health facility - in other words; it covers your "in-patient" treatments. Most Medicare beneficiaries will pay no monthly premium when receiving Medicare Part A. However, there may be a deductible you must pay in order for your benefits to "kick in." This is a common feature of virtually all insurance plans.

Medicare Part B

Medicare Part B is the part of Medicare that covers all forms of "outpatient" procedures. Medicare Part B is also involved in covering medical supplies such as oxygen and even prosthetic limbs. Generally speaking, Medicare Part B will provide 80% of the cost of whatever covered item you claim. You will be responsible for a deductible as well as the remaining 20%. You may also be responsible for a premium.

Other Medicare Parts

Medicare Part C (Medicare Advantage)

Medicare "Part C" is the name given to the general coverage offered by Medicare Advantage Plans. Medicare Advantage Plans are private insurance arrangements that are supervised, but not sponsored, by the federal Medicare program. As mentioned above, they are required to cover "at least" as much as Medicare covers.

This is represented by Medicare Part C, which you can think of as a combination of Part A and Part B. Only Medicare Advantage Plans offer Medicare Part C, which does everything A and B do and may also provide some additional coverage. Patients choose Medicare Advantage Plans to get expanded coverage for areas not covered by Medicare A and B.

For example, Medicare Part C might cover vision issues, including routine eye checkups. These are almost never covered under any provision of Original Medicare. You may wish to choose a Medicare Advantage Plan if you suffer from chronic issues not covered by A and B. Hearing maintenance is another such area.

Medicare Part C plans can also provide extra help for costs associated with insurance, such as your deductible and copayment amounts. Having a Medicare Part C plan can, in rare cases, increase the coverage of treatments to 100% while reducing regularly billed costs.

However, Medicare Part C (Advantage Plans) can also be very complex. The rules that they abide by might change suddenly and unexpectedly. Items that were covered one year may not be covered in the next. When you deal with a Medicare Advantage Plan and choose Part C, you might be subject to all the volatility of any other private business.

Also remember that when you choose a Part C plan, you are not eligible for Medigap, a form of federally sponsored insurance that can help you pay for items not fully covered by your Original Medicare Parts A and B insurance. There will be some trade off in terms of coverage no matter which path you choose.

Medicare Part D (Prescription Drug Coverage)

Medicare Part D is the last major Part of Medicare. Private companies, just like Medicare Part C, administer part D plans. But, unlike Part C plans, patients in conjunction with Original Medicare use Medicare Part D plans. Part D plans cover the costs of medically necessary prescription drugs.

Part D coverage is also available when you are enrolled in a Medicare Advantage Plan under Part C. No matter whether your insurance needs are met by Original Medicare or a private insurer, you will probably wish to adopt Part D coverage. Part D coverage, like Part C coverage, is operated by a variety of businesses. These businesses must meet standards set forth by Medicare, but differ a great deal in coverage.