Coverage Options In Medicare Parts A, B, C and D

June 7, 2012 0 Comments

By Pete Baker

Medicare is a social medical insurance plan managed by the Federal Government to help support the medical-related expenses of the elderly people of the USA (65+). Talking about men and women under 65 years, people that have enduring disabilities and renal malfunction, who need dialysis etc, can certainly enrol for Medicare also.

Medicare coverage primarily is dependent upon the Part of Medicare that a person registers for. 90 days prior to an individual’s 65th birthday, a person receives a Medicare card, which actually proves that an individual has Medicare insurance coverage. Upon becoming 65, one instantly will become entitled to Medicare. In spite of this, s/he must sign up for Medicare in the open registration period, that’s from November 15th until December 31st. Upon signing up for Medicare one gets immediate access to Medicare Part A (Hospital Insurance), that is totally free, that means zero premiums to be paid. Anyone who is eligible for Part A by default becomes entitled to Part B (Medical Insurance) too. Yet, if s/he already receives social security, Medicare Part B might not be needed, it can be opted out of by simply following instructions on the Medicare card.

Medicare has four types, if a person owns one or maybe a combination of these, s/he could receive the following coverage for each and every Part.

Given that Part A is referred to as Hospital Insurance, it covers all of the in-patient hospital fees. These include hospice care and interval term in hospice care, blood transfusion (barring three pints annually), home health care, except for adult supervision, long-term hospital care, although, until two months of hospitalization; after 60 days the policy coverage reduces; on crossing 150 days, the policy coverage ceases. It also insures obesity bariatric surgical procedures, expenses borne by the beneficiary on visiting a non-medical health care establishment that operates on religious grounds, skilled but not private nursing facilities, room services in hospitals excluding TV and VCR in rooms, medical equipments and other such supplies etc, social services, chemotherapy, prescription drugs , anesthesia, conveyance, regular meals, laboratory tests and the like.

Next comes Part B or Medical Insurance. If one chooses to keep this Part then s/he will get coverage on medical expenses and most things that Part A fails to cover. Part B covers 80% of the medical bill and the rest 20% is to be borne by the beneficiary. This 20% is the co-insurance or the co-pay that the beneficiary pays, and of course, there are deductibles too. The medical expenses falling under Part B are outpatient doctor’s/physician’s services, medical and surgical services, glaucoma tests, ambulance conveyance, mental illness, prosthesis, bone mass density measurement, radiation treatments, breast cancer and other cancer screenings, diagnostic tests, cardiovascular tests. It also covers Mammograms, emergency room treatment, radiology and pathology treatment. Unlike Part A, Part B has its premiums for the beneficiaries to pay. The residual 20%, that the beneficiary has to pay could turn out to be an amount that might come to be far from affordable at times. Here there is an option known as Medigap. Medigap plans are Medicare supplement plans that are sold by private insurance companies. These help pay for the expenses that Medicare does not pay for. There are 12 supplement plans that provide different types of coverage and charge different premiums too.

If a person wishes to enroll in to Medicare Part C, s/he must be eligible for both Part A and B. However, Part C plans are more like a combination of Part A and Part B. These are also known as Medicare Advantage Plans, also sold by Medicare approved private insurance companies. There are a number of Advantage plans to choose from, so many that it might confuse the buyer. These plans offer additional benefits at lesser costs as compared to Medicare originally. Also, known as managed care, they include Medicare Health Management Organisations (HMO), Medicare Private Fee For Service (PFFS), Medicare Medical Savings Account (MSA) and Medicare Special Needs, Medicare Preferred Provider Organisations.

Part D plans i.e. prescription drug plans allow the beneficiary to claim a section of the cost of prescription drugs’ cost, to paid by Medicare. Anyone who is eligible for Parts A, B and C gains eligibility for Part D not considering his/her health history and amount if income earned.

This is what all Medicare covers for its beneficiaries. For all those expenses ignored by Medicare, Medigap and Medicare Supplement Plans come to the rescue.

Pete is an expert commentator on Medicare and the various Medicare Plan related topics. For more information on Medicare Parts A, B, C and D, and their benefits, please visit

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