Quickly Decipher the Often-Confusing Alphabet of Medicare

As society mires its way out of the COVID-19 pandemic, health coverage has come into sharp focus for all. The mobilization of the government and the private sector to roll out vaccinations is reminiscent of another landmark program: Medicare.

The coverage for U.S. seniors, implemented in 1965 by the Social Security Act’s Title XVIII, provides hospital care, doctor’s visits and more. Since Medicare can present itself as confusing and overwhelming, four simple letters provide an overview to the system and what it provides.

Medicare, like all health plans, has a sliding scale of costs depending on qualifications, though it is available in its basic form to all people over 65. Some patients will be signed up automatically, and others will go through an enrollment process similar to choosing a health plan. Everyone who navigates the process has questions, and the best place to learn more is medicare.gov, the program’s official site. That said, a great place to start is becoming familiar with Medicare’s four divisions is helpful.

Part A: An original component of Medicare when it was created, Medicare Part A is, at its core, hospital insurance. Typically, Part A pays for inpatient hospital visits, surgeries and related care for up to 60 days after a single deductible. Skilled nursing center stays as a part of rehabilitation can also be covered by Part A, if the rehab is related to a covered surgery or treatment.

In addition, Medicare Part A provides hospice care for patients. It provides full coverage for pharmaceuticals for symptom control, grief counseling, and other related specialty services.

Part B: Like Part A, some people are automatically enrolled in Medicare Part B when they turn 65 or earlier, depending on eligibility or preexisting disability status. Part B is the section of Medicare that covers doctor’s visits, durable medical equipment (mobility devices, safety equipment, etc.) and other outpatient services like preventative medicine or x-rays.

Part B offers low copays and high coverage rates for continuing medical issues, like dialysis or transfusions. The plan can also cover other basic services like lab tests and chiropractic services.

Part C: Medicare Part C, also known as Medicare Advantage, is the section of Medicare perhaps best-known due to extensive advertising and its many appealing perks. This is because Part C is provided through private insurance companies to supplement and expand upon standard Medicare A and B offerings. Medicare Advantage plans meet or exceed the benefits and coverage levels laid out in original Medicare, and in many cases are the best choice for seniors seeking a balance of wellness and coverage for long-term conditions or unexpected health challenges.

Some benefits to having a Medicare Advantage plan include lower copays and more perks, including expanded outpatient care, medical transportation, in-home supportive services, and even meal plans; exercise monitoring equipment, gym memberships, wellness instruction or hearing aids. Since Part C plans are provided by insurers, the best way to learn more is to visit the individual company websites for comprehensive lists of pricing and available benefits.

Part D: Implemented in 2006 and among the newest additions to Medicare, Part D specifically covers prescription drugs and is available to anyone with Parts A and B. The plan covers a wide range of self-administered drugs, including generic and name-brand prescriptions.

This lowers costs for medications needed to treat long-term conditions or keep patients healthy. For those that qualify, the Extra Help program can be added to Part D to lower drug costs further. Those with qualifying Medicare Advantage (Part C) plans make Part D coverage superfluous, as prescription drug coverage is often built into Advantage plans.

Regardless of the health coverage you choose, consult medicare.gov, your primary care provider, health insurance provider or coveredca.org to aid in picking the best plan for you. Learning as much about the benefits prior to making selections can help when considering things like the location of care, keeping your existing doctor or specialist or selecting a trusted new professional, and whether or not prescription drugs you currently take will be covered. Person-to-person help is also available contact-free using telehealth, online, or in-person at group events, or one-on-one.