There are four parts of Medicare: Part A, Part B, Part C, and Part D. Generally, the different parts of Medicare help cover specific services.
• Part A provides inpatient/hospital coverage. • Part B provides outpatient/medical coverage. • Part C offers an alternate way to receive your Medicare benefits (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 pay 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 may help reduce your health care and prescription drug costs if you meet the eligibility requirements. Unless you choose otherwise, you will have Original Medicare. Instead of Original Medicare, you can decide to get your Medicare benefits from a Medicare Advantage Plan, also called Part C or Medicare private health plan. Remember, you still have Medicare if you enroll in a Medicare Advantage Plan. This means that you must still pay your monthly Part B premium (and your Part A premium, if you have one). Each Medicare Advantage Plan must provide all Part A and Part B services covered by Original Medicare, but they can do so with different rules, costs, and restrictions that can affect how and when you receive care.
It is important to understand your Medicare coverage choices and to pick your coverage carefully. How you choose to get your benefits and who you get them from can affect your out-of-pocket costs and where you can get your care. For instance, in Original Medicare, you are covered to go to nearly all doctors and hospitals in the country. On the other hand, Medicare Advantage Plans typically have network restrictions, meaning that you will likely be more limited in your choice of doctors and hospitals. However, Medicare Advantage Plans can also provide additional benefits that Original Medicare does not cover, such as routine vision or dental care. ( Video) If you have a limited income, you may be able to get assistance with your health care costs through certain programs:
• Medicaid: If you have a low monthly income and minimal assets, you may be eligible for coverage through Medicaid to pay Medicare costs, like copays and deductibles, and for health care not covered by Medicare, such as dental care and transportation to medical appointments. • Medicare Savings Programs (MSPs): If you do not qualify for Medicaid but still have problems paying for health care, you may qualify for an MSP, a government-run program that helps cover Medicare costs. There are three types of MSP, and all of them pay the monthly Medicare Part Bpremium. The Qualified Medicare Beneficiary (QMB) program covers deductibles and coinsurances as well. • Extra Help: Also known as the Part D Low-Income Subsidy (LIS), this is a federal program that helps pay for some to most of the costs of Medicare Part D prescription drug coverage. You may be eligible for Extra Help if you meet the income and asset limits. Also, in many cases, enrollmentin an MSP automatically leads to enrollment in Extra Help. • State Pharmaceutical Assistance Programs: SPAPs are offered in some states to help eligible individuals pay for prescriptions. Most SPAPs have income guidelines. Many also require you to enroll in a Medicare Part D plan and to apply for Extra Help. Note: Income and asset limits for the above programs differ from state to state. For more information, call or visit the website of your State Health Insurance Assistance Program (SHIP). (Video)