Medicare A, B, C and D Explained

Each part of Medicare provides different kinds of coverage. Explanations follow:

Part A – helps pay for a stay in the hospital and skilled nursing facilities, home health services, and hospice care – as long as certain conditions are met. There are no monthly premiums if you or your spouse paid sufficient Medicare payroll taxes while working. Otherwise, you can buy Part A services by paying monthly premiums.

Part B – helps pay for doctors’ services, both in and out of the hospital, and outpatient care such as lab work and screenings. Also covered are some medical equipment and supplies, such as wheelchairs and oxygen, if certain conditions are met, and most drugs or vaccines that are administered in a doctor’s office. Unless your income is limited enough to qualify for state assistance, you pay a monthly premium for Part B. Medicare typically pays 80 percent of the Medicare-approved cost of each service and you pay 20 percent. If you have supplemental insurance, it may cover the out-of-pocket expenses.

Part C – provides an alternative way to receive Medicare services through private managed-care plans (HMOs and PPOs).  These plans must cover all the same services as the traditional Medicare program (Parts A and B), but may charge lower copays. The plans may also offer Part D drug coverage and some extras, at their discretion, such as routine dental, vision and hearing care. You may pay a monthly premium in addition to the Part B premium, although some plans charge no premiums of their own. Medicare Advantage plans may restrict your choice of doctors and other providers, or charge higher copays for going out of network.

Part D – helps pay for prescription drugs that you use at home. You can get this coverage in one of two ways: by joining a private “stand-alone” Part D drug plan for an additional monthly premium (if you are enrolled in traditional Medicare), or by enrolling in a Medicare Advantage plan that includes Part D coverage in its benefits package.

From: AARPBulletin/RealPossabilities April 2016.