Understanding Each Part of Medicare

By Michelle Cemental

Almost everyone approaching retirement age has some knowledge about medicare benefits, but far too many people aren't aware of how it actually works. There are several "parts" to medicare which cover different aspects of your retirement healthcare needs. Turning 65? Here is what you need to know about Medicare.

Part A

Part A is also called hospital insurance. This type of insurance covers most hospital visits and related services, including emergency services, hospice and home healthcare. If you have paid into social security for more than 10 years, you should be eligible for this insurance. If you have not paid into SS for that long, you can still receive Medicare A benefits, but you will be required to pay a monthly premium. Part A insurance will become effective at the beginning of the month in which your 65th birthday occurs.

Here is a breakdown of what Part A covers: 

  • Inpatient Hospital Care: Part A provides in-patient care for up to 90 days plus 60 lifetime reserve days in general hospitals and up to 190 lifetime days in a psychiatric reserve hospital.

  • Skilled Nursing Care (SNF) Care: Part A also provides for up to 100 days of care each benefit period. A previous 3-day or longer hospital stay must be had to qualify for these days to be used and therapy must be received 7x per week with speech therapy being given at least 5x per week.

  • Home Health Care: Medicare provides up to 100 days of home-health care if you were in the hospital for at least 3 days in the 14 before receiving home-bound care.

  • Hospice Care: Medicare provides care long as a certified doctor maintains that you are terminally ill and believe to have a life expectancy of 6 months or less left.

Part B

Part B insurance covers regular medical expenses, including doctor visits, medical supplies, ambulance usage and preventative care. With Part B, you'll be required to pay a monthly premium and co-payments. You are eligible for part B if you are 65 or older and you are a permanent US citizen.

Here is a breakdown of Part B: 

  • Preventative doctors care.

  • Durable Medical Equipment: Equipment can be rented from a Medicare-certified store upon certification from your doctor that it's medically necessary.

  • Ambulance Services: If you need ambulance services transportation or if you need to move between certain locations, these services are available.

  • Preventative Care: Most preventative care services such as annual physicals are covered under Part B of Medicare.

  • Outpatient Treatments: This includes anything from speech therapy to occupational therapy services even physical therapy after a trauma such as a car accident or other injuries like a fall or even a stroke or heart attack.

  • Chiropractic Care: Part B covers any chiropractic care that is prescribed to help manipulate or maneuver the spine to help treat any occurring medical conditions.

  • Tests: All lab X-rays and tests that may be necessary to diagnose a condition.

  • Select Prescription Drugs: There are certain prescription drugs covered under Part B of the Medicare health coverage including some immunosuppressants, anti-cancer drugs, and even some dialysis drugs.

Part C

Part C, also called Medicare Advantage Plans, are private health insurance plans approved by medicare. This type of plan essentially lumps A & B together and may also include additional benefits, such as dental, vision and drug coverage. Typically, anyone who has Part A & B can opt for a Medicare Advantage Plan, so long as you reside in the coverage area of the plan you wish to join.

Part D

You can get Part D as an add-on to your A & B coverage. Part D will cover a certain amount of any prescriptions you may need. Part D can sometimes be used in conjunction with medical coverage outside of Medicare. However, recommends keeping your current prescription coverage if you have Federal Employee Health Benefits, Veterans Benefits, or Tricare.

Gap Coverage

Because traditional Medicare does not cover all your health contingencies, it is likely that you will want to sign up for some type of supplemental insurance plan to fill in any gaps in coverage. As with any insurance policy purchase, you will need to carefully evaluate the choices for Medigap coverage and make your decisions based on benefits covered as well as financial considerations.

When to Sign Up

You are eligible to sign up for Medicare when you turn 65. You have seven months to sign up for Medicare, starting three months before you turn 65 and lasting for three additional months after the month you actually turn 65. If you do not wish to sign up for Medicare within this seven-month period, there are a number of alternate opportunities to do so. However, it is important to note that penalties may accrue for late enrollment, depending on your situation.

With a little forethought and planning, you can enjoy the benefits of Medicare in your retirement years. Keep in mind that you must re-enroll into Medicare each year! For more information about Caring Senior Service please contact your local office. We exist to help you!

Tags: Medicare