What are the parts of Medicare? And what exercise they cover?

Learn what Medicare is, how it works, and the services that are typically covered under Parts A, B, C and D.

When I first started my career in the Medicare earth, I realized in that location was a lot of new data I had to learn and constitute that breaking it down into bite-sized chunks fabricated it much easier to sympathize. I started by focusing on all the different parts of Medicare.

Here is a breakdown of what I learned to help yous understand how Medicare works.

What is Medicare?

Simply put, Medicare is a federal wellness insurance program for:

  • People 65 and older
  • People under 65 with sure disabilities
  • People with cease-stage renal affliction

The Medicare plan offers basic coverage to assist pay for things like doctor visits, hospital stays and surgeries.

When you're eligible, yous can enroll in Medicare Parts A and B – also known every bit Original Medicare – through the Social Security Administration. If y'all are already receiving Social Security or Railroad Retirement Board benefits yous'll automatically exist enrolled.

Original Medicare covers the essentials, just there are a lot of services that aren't included – important things like prescription drug coverage, annual hearing and eye exams, care needed when traveling outside the United states and much more. Services like these can be covered through private Medicare health plans and Medicare Office D prescription drug plans.

There are a few different times y'all can enroll in Medicare and a Medicare plan throughout the year. These are chosen enrollment periods.

Check out the graphic below to see when you can enroll, or read the article When and how to apply for Medicare for more in-depth info.

What are the 4 parts of Medicare?

Medicare is broken out into four parts.

  1. Medicare Office A – hospital coverage
  2. Medicare Part B – medical coverage
  3. Medicare Part C – Medicare Advantage
  4. Medicare Part D – prescription drug coverage

What does each part of Medicare embrace?

The parts of Medicare cover dissimilar services:

Medicare Part A

Part A (hospital coverage) covers things like inpatient hospital stays, dwelling health care and some skilled nursing facility care. Together, Medicare Parts A and B are called Original Medicare.

Medicare Part B

Office B (medical coverage) covers things like doctor visits, outpatient services, Ten-rays and lab tests, and preventive screenings.

Medicare Office C

Part C is too known every bit Medicare Advantage. Private health insurance companies offer these plans. When you join a Medicare Reward plan, yous still take Medicare. The divergence is the plan covers and pays for your services instead of Original Medicare. These plans must provide the same coverage as Original Medicare (so yous're not missing out on anything). They tin can too offering extra benefits.

Why exercise I need to buy a private health plan?

Private Medicare health plans – similar Medicare Advantage or Medicare Cost plans – cover everything Original Medicare does, and usually include more than coverage for services you might demand. Plus, they tin can include extra perks and benefits.

Notice out more in the article, 4 reasons to purchase a private health plan.

Medicare Office D

Role D covers prescription drugs.Only private insurance plans offering it. It's usually included in a Medicare Advantage plan or you can get a split Part D plan.

Though Medicare Part B does embrace certain vaccines and medications (based on specific health conditions), Office D provides a much wider range of coverage of vaccines and outpatient prescription drugs.

Read more nearly the differences in Part B and Part D coverage in the article, Does Medicare cover all of my vaccines?

Mutual services that Medicare does and doesn't embrace

Here's general info about what Medicare does or doesn't cover for common health intendance needs. Visit medicare.gov/coverage for more detail. Also, bank check a Medicare health program's Summary of Benefits to learn what's covered.

Medicare has some coverage for acupuncture and it is express to treatment of chronic low back pain. Some Medicare Reward plans have benefits that assist pay for acupuncture services across Medicare such as handling of chronic pain in other parts of the trunk, headaches and nausea.

Assisted living is housing where people go assistance with daily activities like personal intendance or housekeeping. Medicare doesn't comprehend costs to live in an assisted living facility or a nursing home.

Medicare Part A may cover care in a skilled nursing facility if it is medically necessary. This is ordinarily short term for recovery from an illness or injury.

The federal Medicaid program tin aid pay costs for nursing homes or services to aid with daily living activities.

Medicare Role B covers outpatient surgery to correct cataracts. Information technology also pays for corrective lenses if an intraocular lens was implanted. Coverage is one pair of standard frame eyeglasses or contact lenses every bit needed after the surgery.

Medicare Part B covers a chiropractor's manual alignment of the spine when one or more basic are out of position. Medicare doesn't comprehend other chiropractic tests or services like X-rays, massage therapy or acupuncture.

Some Medicare Advantage plans have benefits that help pay for these other chiropractic tests or services.

Medicare covers 100% of the toll for screening colonoscopies. Exam frequency depends on your run a risk for colorectal cancer:

  • In one case every 24 months if you have a loftier hazard
  • Once every 10 years if y'all aren't at loftier risk; or every 48 months after a previous flexible sigmoidoscopy.

If during the colonoscopy a polyp or other tissue is found and removed, Medicare applies additional cost sharing for the services.

Medicare doesn't cover routine heart exams to check your vision. Information technology does cover eye exams if yous have diabetes or other medical conditions like glaucoma or cataracts.

Many Medicare Advantage plans have benefits that help pay for routine middle exams.

Medicare generally doesn't cover eyeglasses or contact lenses. Part B does pay for eyeglasses or contact lenses if you lot demand them after cataract surgery.

Many Medicare Advantage plans accept benefits that aid pay for eyeglasses and/or contact lenses you need to correct your vision.

Medicare doesn't cover hearing aids or pay for exams to fit hearing aids. Some Medicare Reward plans have benefits that assistance pay for hearing aids and fitting exams.

Medicare Part A and Office B cover some home wellness services if you run into certain atmospheric condition. Covered services include:

  • Skilled nursing care or home health aide services that are office-time or occasional (intermittent)
  • Physical, occupational or speech therapy
  • Medical social services

Medicare doesn't embrace 24-hour dwelling care, delivered meals, homemaker services, or personal intendance. Some Medicare Advantage plans have benefits that help pay for the habitation health intendance services Medicare doesn't embrace and they may be limited to certain wellness conditions.

Medicare Part A covers hospice care for terminally ill patients who will live six months or less. Patients concur to receive services that focus on providing comfort instead of curing the disease. Coverage includes items and services for pain relief and symptom management, nursing and social services, drugs for pain management, aide and homemaker services, and spiritual counseling.

Medicare Part B covers outpatient physical therapy, speech-linguistic communication pathology and occupational therapy services if it is medically necessary.

What isn't covered by Medicare?

Original Medicare covers the essentials, just at that place are a lot of services that aren't covered such equally:

  • Deductibles, coinsurance and copays for covered services
  • Most dental care
  • Virtually outpatient prescription medicines
  • Routine eye exams
  • Routine hearing exams
  • Hearing aids
  • Fitness programs
  • Services outside the U.S.

Services similar these tin be covered through a private Medicare plan.

Infographic that summarizes Medicare Part A, B, C and D as described above in the article copy.

What is the difference betwixt Medicaid and Medicare?

Medicare and Medicaid (called Medical Aid in Minnesota) are different programs. Medicaid is not part of Medicare.

Hither's how Medicaid works for people who are historic period 65 and older:

It's a federal and state program that helps pay for health intendance for people with limited income and assets. A basic difference is that Medicaid covers some benefits or services that Medicare doesn't like nursing dwelling intendance or transportation to medical appointments (depending on your state and your eligibility).

If you're age 65 or older and are dual eligible for Medicaid and Medicare, yous may be able to get all your services in one plan. In Minnesota, this programme is chosen Minnesota Senior Health Options (MSHO). An MSHO plan covers medical, prescription drugs, dental, long-term care, and home and community-based services.

Visit your state'southward Medicaid/Medical Assistance website or medicare.gov for more information. Learn more in the article, Tin can I get help paying my Medicare costs?

Accept more than Medicare questions?

We're here to back up yous along the way and so you can proceed to live a better, healthier life. Larn all nigh your HealthPartners Medicare plan options.

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