Medicare consists of four parts: Part A, B, C, and D. Both Part A and B make up what is known as Original Medicare. Part C makes up what is known as Medicare Advantage, and Part D is the prescription drug coverage plan. Plans A and B are federal plans, whereas Medical Advantage and Medical Supplements (Medigap) are individual policies issued by private insurance carriers.
Medicare Part A and B
Medicare Part A is the part of Original Medicare that is also known as hospital insurance because it covers most hospital expenses. Medicare Part A helps cover the costs of medical fees for inpatient care in a hospital, care received from a skilled nursing facility, nursing home care, hospice care, and home health care.
Coverage received from Medicare Part B is split into two parts: medically necessary services and preventative services. If the services you receive or the supplies you require are deemed as necessary for your diagnosis/treatment, then you can expect Part B to jump in to provide coverage. It also helps cover the outpatient care you receive.
Medicare Supplement Plans
Medicare Supplement Plans, also known as Medigap, are not stand-alone plans to enroll in. Medigap Plans are used to help fill the gaps of coverage that Original Medicare does not cover. Medigap helps cover leftover costs, such as copays, coinsurance, and deductibles.
Medicare Advantage Plans, or Part C
Medicare Advantage Plans, also known as MA Plans, provide you the same coverage as Medicare Parts A and B, but can also provide extra coverage. Most Medicare Advantage Plans already include prescription drug coverage, unlike the Original Medicare Plan. In most cases, you will need to use Medicare Advantage-approved providers in order to receive treatment at the lowest cost, but some MA plans offer out-of-network coverage; you will just pay more out-of-pocket.
Medicare Advantage Plans offer five different types of plans: HMOs, PPOs, PFFS, SNPs, and an MSA Plan.
Medicare Part D Prescription Drug Plan
You can enroll in Medicare Part D in one of two ways: as a stand-alone plan while enrolled in Original Medicare or in a Medicare Advantage Plan that includes prescription drug coverage. Medicare Part D is provided by private insurance companies, which each have their own formularies, or list of prescription drugs they will cover, and what tier the drug falls under. Each plan has five to six tiers, and the cost of the prescription drug typically increases as you move up the tiers within your plan. Tiers one and two are usually generic drugs, which are the cheapest drugs. Once you reach tier three, you begin to enter into brand-name drugs, which are more costly than those in lower tiers.
To learn more about each part of Medicare and the coverage they can provide, reach out to Heritage First today by giving us a call at 816-931-0375.
Heritage First offers insurance products and services. We are not affiliated with Medicare or any other government agency. Insurance products are guaranteed by the financial strength and claims-paying ability of the issuing company.