The ABC’s (and D) of Medicare

Do you truly need to know the details of what Parts A, B, C, and D represent? Doesn’t Medicare simply pay a lot of your bills and that is it? All things considered, Medicare’s design is more than a touch bizarre; however, every one of its structure blocks decides the coverage you get and what you pay.

Part A

Medicare Part A is generally depicted as hospital insurance. However, this can be misleading. Part A primarily covers nursing care and certain inpatient services rather than your entire hospital bill.

• Skilled nursing care in hospitals or nursing facilities
• Semiprivate room accommodations
• Meals provided during inpatient stays
• Lab tests, medications, medical supplies, and rehabilitation services
• Hospice and certain home health services

Most people qualify for Part A without paying premiums because payroll taxes funded it during their working years. However, deductibles and co-payments may still apply.

Part B

Medicare Part B, known as medical insurance, covers doctor visits, outpatient care, and preventive services.

• Physician services in offices, hospitals, or outpatient facilities
• Diagnostic and lab testing
• Preventive services like screenings and vaccinations
• Medical equipment such as wheelchairs and oxygen
• Outpatient mental health services
• Ambulance services when medically necessary

Part B requires a monthly premium. Most beneficiaries also pay approximately 20% of approved service costs under traditional Medicare.

Part C

Medicare Part C, also called Medicare Advantage, is an alternative to Original Medicare. These plans are offered by private insurance companies and must provide at least the same coverage as Parts A and B.

Many Medicare Advantage plans offer additional benefits such as vision, dental, hearing, and prescription drug coverage. Costs and provider networks vary by plan.

Part D

Medicare Part D covers outpatient prescription medications. Coverage is provided through private plans and varies significantly.

• Coverage occurs in multiple payment stages throughout the year
• Each plan has its own formulary (covered drug list)
• Copayments and pricing vary widely
• Plans may require prior authorization for certain medications
• Plans may change premiums and benefits annually

Settle on Timely Decisions

Medicare requires important enrollment decisions within specific timeframes. Missing deadlines can result in penalties or delayed coverage.

• Enroll during the correct enrollment period
• Compare Original Medicare and Medicare Advantage options
• Determine whether to add Part D drug coverage
• Consider supplemental Medigap insurance if applicable
• Review and adjust coverage annually as needed

This Medicare resource was provided by Amerus Insurance Group, a nationwide independent agency that helps seniors confidently compare plan options, control out-of-pocket costs, and enroll with the right coverage for their doctors, prescriptions, and lifestyle. Whether you’re new to Medicare or reviewing your current plan, speak with an Amerus advisor for a free, personalized consultation.