Dear Marci,
I will turn 65 soon and need to enroll in Medicare. I’ve heard that there are different parts of Medicare. What are those parts?
-Aurelio (Cleveland, OH)
Dear Aurelio,
There are four parts of Medicare: Part A, Part B, Part C, and Part D.
- Part A provides coverage for inpatient hospitalization, skilled nursing facility stays, home health care, and hospice care.
- Part B provides outpatient coverage, including for physician services, diagnostic tests, durable medical equipment, and outpatient hospital services.
- Part C is an alternate way to receive your Medicare benefits; provides Part A inpatient/hospital and Part B outpatient/medical coverage and supplemental benefits not covered by Original Medicare (see below for more information).
- Part D provides prescription drug coverage.
Most beneficiaries choose to receive their Parts A and B benefits through Original Medicare, the traditional fee-for-service program offered directly through the federal government. It is sometimes called Traditional Medicare or Fee-for-Service (FFS) Medicare. Under Original Medicare, the government pays directly for the health care services you receive. You can see any doctor and hospital that takes Medicare (and most do) anywhere in the country.
In Original Medicare:
- You go directly to the doctor or hospital when you need care. You do not need to get prior permission/authorization from Medicare or your primary care doctor.
- You are responsible for a monthly premium for Part B. Some also pay a premium for Part A.
- You typically owe a coinsurance for each service you receive.
- There are limits on the amounts that doctors and hospitals can charge for your care.
If you want prescription drug coverage with Original Medicare, in most cases you will need to actively choose and join a stand-alone Medicare private drug plan (PDP).
Note: There are a number of government programs that help reduce your health care and prescription drug costs if you meet the eligibility requirements.
Unless you choose otherwise, you will have Original Medicare when you enroll in Medicare. Instead of Original Medicare, in most areas you have the option of getting your Medicare benefits from a Medicare Advantage Plan, also called Part C or Medicare private health plan. This means that you must still pay your monthly Part B premium (and your Part A premium, if you have one). Medicare Advantage Plans must offer, at minimum, the same benefits as Original Medicare (those covered under Parts A and B) but can do so with different costs and coverage restrictions. You also typically get Part D as part of your Medicare Advantage benefits package (MAPD). Many plans also cover supplemental benefits that are not covered by Original Medicare, like dental care, vision care, and gym memberships. Many different kinds of Medicare Advantage Plans are available. You may pay a monthly premium for this coverage, in addition to your Part B premium.
-Marci
