What do you need to know about Medicare Part A?
The services you can expect from Medicare Part A include the following:
- Inpatient hospital services – This type of care will typically be covered after your doctor has formally admitted you to stay at the hospital. It should cover up to 90 days during your benefit period with an additional 60 reserve days. You would also be covered up to 90 days in a psychiatric hospital as long as it is a Medicare-certified facility.
- Skilled nursing facility care – Medicare Part A covers the cost for a person to stay in a skilled nursing facility. This includes room, board, and other services you may need during your stay. For instance, it usually covers medications, tube feedings, and wound care. You should be covered for up to 100 days during a benefit period. However, you need to qualify for this service by having spent a minimum of three consecutive days at a hospital for inpatient care. In addition, the days you were in the hospital must have been within 30 days of being admitted into the facility. For Part A to pick up the cost of these services, you might have to show that you need skilled nursing care and therapy sessions.
- Home health care – Medicare Part A will also cover some in-home medical and mental health services. You should be covered for up to 100 days for daily home care services. The plan also covers unlimited days for intermittent care. However, to get these services covered, you must stay for three consecutive days in the hospital for inpatient care within 14 days of starting home health care services.
- Hospice care – Medicare Part A typically covers hospice care services, and you should be covered for however long you need the care.
What do you need to know about Medicare Part B?
Medicare Part B coverage and rules include the following:
- Durable Medical Equipment – This includes equipment that you need for medical purposes.
- Provider Services – This is coverage for medical services that you get from a fully-licensed health provider.
- Ambulance Services – Medicare Part B will cover emergency ambulance services, usually to and from a hospital. It may also cover non-emergency ambulance services in situations where you need medical help and have no safe way to get to a hospital.
- Home Health Care Services – This plan covers skilled nursing care and home therapy services if you are homebound.
- Preventive Care – This plan offers screening and counseling services that are needed to detect medical conditions and prevent illnesses. Most of the time, you won’t be required to pay a coinsurance for these services.
- Chiropractic Care – Medicare Part B may cover some or all of this type of care if deemed medically necessary.
- Therapy Services – This includes occupational therapy, speech therapy, and outpatient physical therapy services.
- Mental health services – Some mental health services are covered under this program.
- Some X-ray and Lab Tests – You can expect some x-rays and lab tests also to be covered under Medicare Part B.
- Various Prescription Drugs – Some anti-cancer, antiemetic, dialysis, and immunosuppressant drugs are usually covered under this type of Medicare plan. You might find many other medications that are prescribed by your doctor that will also be covered.
What do you need to know about Medicare Part C?
Known as Medicare Part C or Medicare Advantage Plans, these plans are private health plans offered by insurance companies. To enroll in a Medicare Advantage Plan, you need to be enrolled in Original Medicare.
There are different Medicare Advantage Plans available. Some may offer prescription drug coverage, dental/vision care, caregiver training/counseling, and some in-home care, including housekeeping. You need to be aware that not all MA plans have these additional coverages. You should speak with a Medicare specialist to see what plan is best for your situation.
What do you need to know about Medicare Part D?
Medicare Part D will help a person with the cost of prescription drugs.
If you are enrolled in Original Medicare and have a stand-alone plan from a private company, you will most likely be able to get Medicare Part D. This plan might also be offered as a feature of a Medicare Advantage Plan.
Medicare Part D plans cover a list of prescription drugs. This is called a formulary. In most cases, Medicare Part D plans will cover at least two different drugs from each one of the following categories:
- Antidepressants
- AID/HIV treatments
- Anticonvulsive treatments
- Antipsychotic drugs
- Anti-cancer drugs
- Immunosuppressant drugs
Medicare Part D plans will also help with most vaccines unless they are already covered under Medicare Part B.
Make sure to speak with a specialist to determine if your prescription will be covered under your Medicare plan.