“Medicare Benefits” is health insurance for people generally for those on disability or age 65 and older. There are four parts of Medicare and each part covers certain benefits. They are labeled as Parts A, B, C, and D. Part A and Part B together are known as Original Medicare which is government sponsored.
While the term Medicare may be well known, a lot of people (even people currently receiving Medicare benefits) do not have a clear understanding of the things Medicare covers. Keep reading to get a general idea of the types of services and benefits each part of Medicare will cover.
Part A – Hospital insurance
Typically, Part A is the coverage that will apply if you are admitted into a hospital as an inpatient. Medicare benefits Coverage includes:
- Hospital Care
- Skilled Nursing facility care
- Hospice Care
- Home health services
- Nursing home care (if more than just non-medical assistance is needed)
Part B – Medical insurance
Medicare Part B is typically thought of as the part that covers physician office visits and medically necessary services. These Medicare benefits include:
- Preventive care (annual wellness checks) and vaccinations (like flu shots)
- Durable Medical equipment (items like walkers, wheelchairs, or oxygen equipment, etc.)
- Ambulance services
- Mental health services (as inpatient or outpatient)
- Diabetic supplies (monitors and test strips)
Part C – Medicare Advantage
Medicare Advantage is bought from an insurance carrier and is required to cover as much as Parts A and B or better. You must have Part A and B to get a Medicare Advantage plan. Also, most of them will include prescription drug coverage, eliminating your need for a Part D plan. They cover additional things not covered by Original Medicare as well. Medicare Advantage plans help cover:
- Some Vision
- Some Hearing
- Some Dental
- Health Wellness programs
Part D – Prescription Drug insurance
As Part D Prescription Drug plans are ones bought from insurance carriers, the formulary of covered drugs will differ carrier to carrier. If formulary changes occur mid-year regarding one of the drugs you are taking, Medicare requires that your carrier must do one of the following:
- Provide you with a notice by mail of the change 60 days or more prior to the change effective date
- When you request a refill (like through mail order), they mail you a notice and a 60 day supply of the drug using the rules as they were before the change
Learning what Medicare covers and how exactly that coverage applies to your situation at the time is crucial to making sure that you select the correct coverage when you sign up for Medicare initially and when making changes each year during the Annual Enrollment Period.
Please reach out with any questions on your Medicare benefits and coverage questions to American Exchange at 423.424.0586 or email us at info@americanexchange.com.
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