Cathy Parvino
Understanding the ABCD's Medicare
Medicare consists of various programs, commonly referred to as parts.
When signing up, individuals can select either Original Medicare, covering Parts A and B, or Medicare Part C, also known as Medicare Advantage.
Medicare Part A
Medicare Part A is widely known as hospitalization insurance, offering coverage for various essential services:
- Hospital inpatient care
- Skilled nursing facility inpatient care that is not custodial or long-term
- Hospice care
- Home health care services
Medicare Part B
Medicare Part B caters to various healthcare requirements beyond hospitalization. This segment offers coverage for:
- Essential medical services encompass doctor consultations, tests, and additional services necessary for diagnosing or addressing your health condition
- Preventive care services include routine screenings, check-ups, vaccinations, and similar measures to maintain your health
- Support for clinical research endeavors
- Ambulance services
- Provision of durable medical equipment
- Mental health services
- Limited coverage for outpatient prescription drugs
Collectively, Medicare Parts A and B are referred to as Original Medicare.
Medicare Part C
Medicare Part C, also known as Medicare Advantage, consolidates the coverage provided by Parts A and B into a single plan administered by private health insurance companies under contract with Medicare. It is required by law for Advantage plans to offer coverage at least equivalent to that of Original Medicare, although the network may provide additional benefits or variations in rules. Many Advantage plans also incorporate Part D, which covers prescription drugs.
Common Part C plans consist of:
- Health Maintenance Organization (HMO) plans
- Preferred Provider Organization (PPO) plans
- Private Fee-for-Service (PFFS) plans
- Special Needs Plans (SNPs)
- HMO Point of Service Plans (HMOPOS)
- Medicare Medical Savings Account (MMSA)
Enrollees in Part C plans can compare plans, benefits, and premiums annually during the Annual Election Period.
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