The Parts of Medicare

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The different parts of Medicare must be confusing to you. Knowing the key points and benefits of each plan makes understanding it easy. The purpose of this article is to help you choose which Medicare Part A, B, C, or D is right for you. 

Medicare: what is it?

It is a federally funded health insurance program for persons over the age of 65 or with end-stage renal disease if they are younger than 65. With the exception of a few individual Medicare benefits, there is no dollar limit on Medicare services as long as they are medically necessary.

Medicare Has Four Parts. What Are They?

There are four parts to Medicare: A, B, C, and D.

Medicare Part A covers hospital stay, while Medicare Part B covers doctor visits. Medicare Part C is approved by private companies, and Medicare Part D covers prescription drugs and vaccines.

Here, we'll explain what each plan covers and what you'll need to enroll.

Medicare Parts: What Are They Covered For?

Part A of Medicare

Hospital coverage is also known as Medicare Part A. Here is a summary:

  • Hospital inpatient care
  • Nursing care in skilled nursing facilities
  • Care in a nursing home (not custodial or long-term)
  • Care provided by hospices
  • Healthcare at home

Medicare Part A has two types: premium-free and premium.

Premium-free package part A

Medicare Part A is premium-free for most people who pay Medicare taxes while employed. At 65, you can apply for premium-free Part A if you meet the following criteria:

  • Social Security or Railroad Retirement Board benefits are part of your retirement plan.
  • Even if you haven't filed for Social Security or Railroad Retirement benefits, you're still eligible.
  • You or your spouse held government employment that was covered by Medicare.

Those under 65 can get Part A for free if they meet the following criteria:

  • Disability benefits from Social Security or Railroad Retirement Board for at least 24 months are required.
  • End-stage renal disease (ESRD) affects you

Part A premiums

You can purchase Part A instead if you do not meet the above qualifications. In 2023, the premium will be $274 or $499 per month. Depending on how long you or your spouse paid Medicare taxes, your premium payment will vary.

It is necessary to have Medicare Part B (Medical Insurance) to purchase Part A.

Original Medicare is also known as Medicare Parts A and B combined.

Click here for more information about Medicare Enrollment.

Part B of Medicare

The following are covered by Medicare Part B, also known as Medical Coverage:

  • Services for outpatients
  • Research in clinical settings
  • Service of ambulances
  • DME (durable medical equipment)
  • Psychiatry (inpatient, outpatient, and partial hospitalization)
  • Medications available only to outpatients

In the case of medically necessary and preventive services, Medicare will approve your claims.

In order to diagnose and treat you according to the accredited standards of medical practice, medically necessary services must be provided.

Early detection of your medical condition is the focus of preventive services.

Premiums for Part B

Part B premiums begin at $164.90. Income-based premiums may be higher.

Part C of Medicare

Despite not qualifying for Medicare Part A and B or Original Medicare, you can still buy a Medicare Plan from a private company. A Medicare Advantage Plan or Medicare Part C can help in this situation.

Original Medicare Part C provides the same coverage.

Each Part C plan has a different monthly premium. A Medicare Advantage plan allows you to choose what medical services are covered, unlike Original Medicare.

Part D of Medicare

Vaccines and medications covered by Medicare Part B may vary depending on your medical condition, but Part D covers a much wider range.

Part D covers the following categories of prescription drugs:

  • Treatments for HIV/AIDS
  • Medications for depression
  • Medications that are antipsychotic
  • Treatments for seizure disorders that are anticonvulsant
  • Anti-immunosuppressive medications

The Medicare Part D formulary also lists covered drugs. You will have to appeal if your prescribed drug is not on the formulary. It is also possible that you will have to pay out-of-pocket.

In addition to drugs outside the formulary, Medicare has also excluded some drugs based on federal law. Among these are weight loss and gain drugs, as well as over-the-counter medications.

If you are not sure whether your prescribed drug is covered under Part A, B, or D, you can consult your physician.

Part D premiums vary by plan as well. Income-related premiums may apply just like Part B.

The bottom line

By comparing the benefits and coverage of Medicare Part A, B, C, and D, you can easily understand their differences. 

Inpatient care is covered under Medicare Part A, while outpatient care, preventive care, and some vaccines are covered under Medicare Part B. Part C or Medicare Advantage Plans are available from private companies if you are not eligible for Part A. Prescription drugs not covered by Part B are covered by Part D. 

There is also a difference in the premium payment between Part A, B, C, and D. If you have Social Security or Railroad Retirement benefits, you may be exempt from paying Part A premiums. Your salary will determine your Part B, and D premiums.