When a person is eligible for Medicare Services upon reaching age 65 or older, or has certain health disabilities, a Medicare participate can utilize any of the four parts to Medicare Services for health insurance coverage. Understanding the four parts of Medicare does not have to be complicated although some consumers may perceive Medicare as rather challenging and confusing to understand. Often times, there are social worker in the hospitals or at skilled nursing facilities that take the time to help individuals understand their health insurance coverage.
Medicare Services Part A
In reviewing the four parts to Medicare insurance, Medicare that covers inpatient care is considered Medicare Part A. This is commonly known as Hospital Insurance. Medicare Services Part A coverage also extends to helping those in need of skilled nursing facility care, hospice services or home health care services. For example, should a Medicare participate be in need of wound dressing and observation by a nurse at home, a physician may order home health care services under Medicare. This home care service is covered by Medicare should the Medicare participant be considered homebound and have a taxing effort to leave their home. There is no co-pay or out of pocket expense for this home care service as this is considered only short-term intermittent care.
Medicare Services Part B
When a Medicare participant is in need of preventive care such as routine doctor visits or outpatient physical therapy, Medicare Part B is utilized. Medicare Services Part B generally pays 80% of the Medicare – approved amount for covered services. It is designed to keep chronic conditions from getting worse and to help educate participates with their disease process. It is important to note Medicare Part A and Part B services can not be used simultaneously. For example, if a Medicare participant has a physician office visit on a Tuesday, the home health care nurse cannot come to the patient’s house receiving home care services the same day. The home care nurse would ideally need to come the next day.
Medicare Services Part C
When Medicare Part A and Part B are combined, coverage is considered Medicare Part C. Funding of Medicare Part C comes from private insurance companies that have been approved by Medicare. Most Medicare Part C Plans do provide prescription drug coverage. Medicare Part C is also known as Medicare Advantage Plans which consist of either:
- Preferred Provider Organization Plans (PPO)
- Health Maintenance Organization Plans (HMO)
- Private Fee-For-Service Plans (PFFS)
- Medical Savings Account Plans (MSA)
It is important to note when considering a Medicare Part C plan, not all Medicare Advantage Plans work the same way. By taking the time to find out the plan’s rules, what expected costs will be to your health care needs, and whether the plan will meet your specifications should be taken into consideration. Some organizations where consumers can purchase Medicare Advantage Plans are Humana, United HealthCare or Blue Cross and Blue Shield just to name a few.
Medicare Services Part D
Lastly, Medicare Services Part D is for prescription drug coverage which helps covers the exurbanites cost of prescription medicines. Prescription drug coverage is run by private companies approved by Medicare, which can either be Medicare Advantage Plans or separate Medicare Prescription Drug Plans. Before considering a Part C or Part D plan, it is wise to review the out of pocket expense of each medication you may be taking for budgeting purposes.
By taking the time to research and understand Medicare coverage, caregivers and seniors alike can make prudent decisions to meet their health care needs. Discussion with family and friends and what health care options that they may utilize can help bring peace of mind to making sound decisions. SilverCensus, an unbiased, National Senior Living and Health Care Directory, believes it is best to be well informed of consumer health care rights and options to avoid a health care crisis.
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