Learn the A B C & Ds of Medicare at MedicarePhD

LEARN YOUR ABC & D’s

PART A - HOSPITAL

PART B - PHYSICIANS

PART A AND B – BENEFITS

PART C - PRIVATE PLANS

PART D - PRESCRIPTION DRUGS

SUPPLEMENTAL OR MEDIGAP PLANS

OK, Part A is the hospital section of Medicare and provides coverage for inpatient hospital stays, skilled nursing facility care, limited home health care, and hospice. There are applicable deductibles and co-pays as we have already informed you that Medicare does not pay all of your medical expenses.

The Part B division pertains to doctor’s visits, outpatient care, lab services, preventative care such as flu shots, colorectal and prostate screenings, mammograms plus most x-rays and durable medical equipment (wheelchairs, etc). As with Part A, there are deductibles and co-pays.

Part A & B are generally described as “Original Medicare” and almost everyone 65 and over is eligible for these medical benefits. An entire website could be devoted to the A & B benefits and the exceptions pertaining to each item, but we provide below a quick reference of services covered and those not eligible. A complete breakdown is included in the government publication “Medicare & You” which we will later tell you how to obtain, and it is the only publication outside of this website that you might want to acquire.

Please realize that the following are generalizations with most services having some qualifications, time limits, co-pays, and deductibles. Medicare Part A & B are designed to assist you with health care expenses, not provide complete coverage.

PART A PROVIDES:

• Inpatient hospital services

• Drugs administered in the hospital

• Skilled nursing facilities

• Limited home health care

• Hospice

After researching all of the diseases and medical services covered or exempted, I immediately began to experience major symptoms of the majority of them and decided to proceed immediately to my local hospice. However, they somewhat rudely informed me that they do not assist those in good health, but if it would make me feel any better, I could go home and get my affairs in order. Before going in that direction, let’s see what this Part C is all about.

Part C in the Medicare structure refers to private insurance plans that are approved by Medicare. Generally referred to as Medicare Advantage Plans, they are required by law to provide equal or superior services in relation to original Medicare, but they can charge differing out of pocket costs.

The Medicare Advantage system entails the federal government paying a private insurance company usually between $750 to $900 per month to take over the responsibility of providing you Part A and B insurance coverage, plus in most instances prescription drug coverage. The company is gambling they can provide this service to you for less than the government payment, and thus this is how they make a profit.

Original Medicare does not cover prescription drugs, only drugs administered in the hospital or in a physician’s office. Thus, Part D of the Medicare equation was enacted in 2006 and is referred to as Medicare Prescription Drug Coverage.

While we go into greater detail in an upcoming section, one of your options is to stay in the Original Medicare program and purchase a free standing drug plan from a private insurer who has been approved by Medicare. The second alternative is to join a Medicare Advantage Plan (Part C) that includes prescription drug coverage as part of the package.

There are a large number of these plans available to you (50 in the county I reside) and they vary in terms of cost, what pharmacies you use, co-pays, and formularies (list of drugs they will pay for). Once again you wonder how you can choose among up to 50 plans, but being the highly intelligent individual you envision yourself to be, you have visited the perfect website to provide you the proper direction.

Go to Next Section:

12 Most Asked Questions on Part A and B >>

Just when you thought you understood your A, B, C & D’s, good ole’ Medicare launches one more piece into the puzzle, Medicare Supplement Plans more commonly referred to as Medigap Plans. If you are turning 65 and have numerous medical issues, this is a type of policy you want to strongly consider. Conversely, if you are healthy and seldom see a doctor, we do not recommend these plans.

Medigap insurance companies can only sell eleven standardized plans (A through L) and the ONLY DIFFERENCE AMONG THESE POLICIES IS COST AND AGENT SERVICE. While they definitely relieve you of the majority of deductible and co-pay expense associated with Part A & B, they do require a premium payment (unlike many Medicare Advantage policies) and they provide no prescription drug coverage. More details are forthcoming in a later section on MedicarePhD website.

Medicare is simply a federal health plan for people 65 and older and some categories of disabled individuals that are under 65. For reasons that we are not going to question, Medicare is divided into four areas; A, B, C, & D. Each of these letters signifies a separate area of Medicare coverage and we are going to assume that this is the first exposure for many of you to these four segments.

A quick aside should make you feel better if you are a complete novice in the field. Knowing absolutely nothing about Medicare, I attended my first community meeting sponsored by a major insurance company. The agent almost immediately started discussing “Part B” and I raised my hand and informed him I did not know what “Part B” meant. He looked at me like he basically had never encountered a life form such as myself, and gave a very brief explanation. The moral of the story is, IF YOU DO NOT WANT TO BE VIEWED AS AN ALIEN, finish reading this website, MedicarePhD.

PART B PROVIDES:

• Physician services

• Outpatient—Emergency room/surgery centers

• Mental illness

• Screenings—Colon, prostate, bone mass, cardio,

diabetic, glaucoma and mammograms

• Exams—Pelvic, pap, breast + x-rays

• Shots—Flu, pneumonia + hepatitis B

• Clinical Lab—Blood, urinalysis

• Physical, speech, occupational therapy

• Radiology services

• Ambulance

• Drugs administered by a physician

• Diabetic supply

• Durable medical supply—wheelchairs, prosthetics, etc.

• Misc—Smoking cessation, 2nd opinions, kidney dialysis

• Limits on out of pocket spending

• Care outside of the U.S.

• Drugs outside hospital or Dr’s office - -

prescription drugs

• Long term care

• Custodial care—assist dress, bathe, eat

• Routine eye, hearing, dental, foot,

chiropractic

• Cosmetic surgery & acupuncture

• Routine physicals

Medicare Advantage Plans were instituted in 1997 and are surrounded by continual controversy, primarily in response to the amount of the monthly guaranteed payment. However, over 11 million Medicare recipients (1 in 4) have a Medicare Advantage Plan and it is actually surprising that more individuals do not take advantage of this product.

In a later section we will analyze these plans and make the recommendation that you strongly consider availing yourself to one of these policies. Many provide excellent coverage beyond what is provided by Original Medicare and they generally CAN BE OBTAINED AT NO COST.

Medigap policies are outside of the Medicare system and are provided by private insurance companies that are strictly regulated by the federal government. The intent of these policies is to assist you in paying your share of Medicare covered services such as deductibles and co-pays. Remember, Medicare does not pay 100% of your health care costs and in general you are responsible for approximately 20% of the total expense.