Breakdown: Understanding What’s Covered by Medicare

Since Medicare is broken down into four parts (A, B, C, and D), it can be difficult to understand what is covered and whether you need additional coverage from another insurance plan. Failing to understand Medicare protection may result in wasted money if you end up with too much or too little coverage.

Each Medicare Part covers different medical expenses, as is shown by the following:

What Does Medicare Part A Cover?

People with Medicare Part A rely on this portion of Medicare to pay for inpatient hospital says, skilled rehabilitative support and home health. Unlike Part B, Part A generally covers 100% of medically necessary procedures, including lab tests and surgery.

What Does Medicare Part B Cover?

When outpatient medical care is needed, Medicare Part B covers approximately 80% of the cost. Covering both preventive and medically necessary procedures, services and supplies, Medicare Part B provides much-needed coverage – up to 100% – for routine physician’s services.

Though coverage of outpatient services is most common, Medicare Part B also covers mental health care, medical equipment, a portion of ambulance costs and partial hospitalization services. If you need a second opinion about your diagnosis or recommended course of treatment, Medicare Part B will pick up the tab.

What is Medicare Part C & What Does Medicare Part C Cover?

Medicare Part C is what is known as a Medicare Advantage Plan, or an MA Plan. These plans are offered by Medicare-approved, private companies. If you join a Medicare Advantage Plan, you still have Medicare coverage. You have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.

Medicare Advantage Plans cover all Medicare services and may also offer extra coverage. Like private insurance companies, Medicare assigns a standard rate of pay to medical services, which providers must accept before agreeing to see Medicare recipients. To compare Medicare Advantage plans, review the differences in out-of-pocket expenses for each plan. Because Medicare’s rules may change annually, it’s important to keep up with healthcare-related news.

What Does Medicare Part D Cover?

Similar to private health plans, Medicare Part D provides coverage for prescription drugs. Using a tier system, Medicare Part D calculates the cost of medication and pays a percentage of it. Typically, brand name medications will be included on a more expensive tier, while generic medication is typically the least expensive.
When attempting to reduce medical expenses, ask your physician if a generic medication is available to treat your symptoms.

Do I Need Supplemental Insurance if I Have Medicare Coverage?

To avoid excessive out-of-pocket expenses for services Medicare does not cover, you may want to consider supplemental insurance. Two of these plans are Medigap and Medicare Advantage:

Medigap: Acting as a supplement to Medicare, Medigap is designed to reduce out-of-pocket medical expenses. Though prescription drugs aren’t covered, Medigap receives your medical claim after Medicare’s portion is paid.

Medicare Advantage: For those who seek more comprehensive coverage, Medicare Advantage is a good option. Approximately 30% of Medicare recipients qualify for this plan, which is billed in addition to Medicare premiums. Like a private health plan, Medicare Advantage plans include set copays and deductibles based on the service received. Once out-of-pocket expenses are capped for the year, Medicare begins to pay your portion.

Reduce out-of-pocket medical expenses by choosing healthcare providers within your plan’s network. Unfortunately, Medicare Advantage cannot be paired with Medigap to reduce expenses.

Medicare can be confusing. That’s why it’s important to consult with someone who can help you navigate through the red tape and help you choose the plan that best fits your healthcare needs.

Category: Medicare Facts, Tips, and Tricks