Parts of Medicare

Medicare consists of four different parts: 

  • Part A, hospital insurance
  • Part B, medical insurance
  • Part C, Medicare Advantage
  • Part D, prescription drug coverage 

Medicare Part A

Medicare Part A is your hospital insurance. It will cover:

Inpatient hospital care when you’re admitted to the hospital as an inpatient after a doctor’s order says it’s necessary and the hospital accepts Medicare. In some cases, the hospital’s Utilization Review Committee will need to approve your stay.

Skilled nursing facility care is covered when you have a qualifying hospital stay, and your doctor has decided you need daily skilled care related to your qualifying hospital stay.

Nursing home care is covered when custodial care (the kind of care that supports regular daily living like bathing and dressing) isn’t the only kind of care you need, and it’s been deemed medically necessary for you to have skilled nursing care. 

Hospice care is covered, including all items and services needed for pain relief and symptom management, pain management drugs, durable medical equipment for pain relief and managing symptoms, aide and homemaker services, spiritual and grief counseling, and medical, nursing, and social services.

Some home health care is covered, usually including part-time skilled nursing care, occupational therapy, physical therapy, medical social services, speech-language pathology services, part-time home health aide services, and injectable osteoporosis drugs for women.

Medicare Part B

Medicare Part B is your medical insurance. It covers medically necessary services and preventive and screening services. 

Medically necessary services include services or supplies that are needed to diagnose or treat your medical condition. Preventive services include medical care to prevent illness or detect it early when treatment is likely to be most effective. 

Medicare Part B covers things like:

  • Durable medical equipment
  • Ambulance services
  • Clinical research
  • Mental health – inpatient, outpatient, and partial hospitalization 
  • Shots
  • Screenings
  • A yearly wellness visit
  • Limited outpatient prescription drugs

Medicare Part C

Medicare Part C is also called Medicare Advantage. Part C is a bundled alternative to Original Medicare offered by Medicare-approved private companies required to follow Medicare’s rules. These plans often include prescription drug coverage and may include additional coverage like vision, hearing, dental, and/or fitness programs. 

Medicare Advantage plans offer financial protection by placing a limit on your out-of-pocket costs each year for covered services. Most plans require you to use medical providers who are in-network for the plan. However, some plans do offer out-of-network coverage (usually at a higher cost). 

There are five different types of Medicare Advantage plans, with the first two plans being the most popular: 

  • Health Maintenance Organization (HMO) Plans  
  • Preferred Provider Organization (PPO) Plans
  • Private Fee-for-Service (PFFS) Plans
  • Special Needs Plans (SNPs)
  • Medicare Medical Savings Account (MSA) Plans

Medicare Part D

Medicare Part D covers the cost of your prescription medications (including many of the recommended vaccines and shots). Part D is highly recommended as an add-on to Original Medicare, as prescription drugs can be quite expensive on their own,

Get The Medicare Coverage You Need

Coastal Insurance Planning can help you get the Medicare coverage you need. We’re here to help you have a peaceful retirement and the ease of mind that comes from knowing that your health care needs are taken care of. Give us a call today to learn more about the different parts of Medicare.