Medicare 101: A Breakdown of Parts A, B, C, and D

If you’re someone who is currently researching Medicare and its parts, this blog is for you!

You could be a person who is nearing the age of 65, or want to know more about the program to get one of your family members or friends enrolled in the program. By the end of this blog post, you will have a clear picture of how Medicare and its parts work.

To start with, Medicare is one of the most trusted programs that provides healthcare coverage for millions of seniors in the United States. While more than half of the population is aware of Medicare benefits, people mostly get confused between the Medicare coverage gap and Medicare chairlift coverage.

In this blog, we will start exploring the different parts of Medicare and understand if chair lift is really covered by Medicare. Come let’s get started!

Why is there a Medicare program? How does it help the seniors?

Medicare is a Federal health program that was established in the year 1965 that helps seniors aged 65 or older with several healthcare needs. It also offers healthcare benefits for younger individuals with specific disabilities.

The Medicare program helps seniors to maintain their health whenever they deal with any major or minor issues. The program also ensures that seniors get essential medical services, hospital care, and prescription medications. Without Medicare, many seniors would find it difficult to deal with rising healthcare costs, especially those individuals who face financial difficulties.

All about Medicare parts [A, B, C, and D]

There are four parts to a Medicare program, and each part exists to serve a specific purpose in covering different aspects of Healthcare. Let’s see a brief overview of what each part covers.

1. Part A

   • This part majorly covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health services.

   • It helps seniors who require hospitalization or skilled nursing services.

2. Part B

   • It covers outpatient care, doctor visits and tests, preventive services, durable medical equipment, ambulance services, outpatient therapy services, limited outpatient prescription drugs, and home health services.

3. Part C

   • This is also called a Medicare Advantage plan and is offered by private insurance companies approved by Medicare.

   • They are gaining popularity as they combine the benefits of Part A, B, and sometimes Part D into a single package.

   • Along with this coverage, additional benefits like dental, vision, and fitness programs are also offered.

4. Part D

   • This is specifically established to cover prescription drugs.

   • This Part would be helpful for seniors to afford the medications they need to manage and keep their health situation in control.

Now that we have an idea of what is covered in these Medicare Parts, in the upcoming sections we will learn about each part in detail, and discuss its various coverage options and the eligibility requirements.

Medicare Part A

Part A, being the primary part of the plan, serves as the foundation of Medicare coverage providing seniors with the benefits of hospitalization and skilled nursing care.

What does it cover?

1. Hospital care - This includes inpatient hospital stays, care in a critical access hospital, and mental health care in a psychiatric hospital.

2. Skilled Nursing Facility Care - It offers essential medical care in a skilled nursing facility followed by a qualifying hospital stay.

3. Hospice care - This includes hospice services for individuals with a terminal illness and a life expectancy of six months or less.

4. Home Health Services - Part A covers home health services like part-time skilled nursing care, physical therapy, speech-language pathology services, and more as long as you’re homebound as stepping out of home is not recommended due to your health condition.

What are the 3 eligibility criteria for qualification?

To be eligible for Medicare Part A, you need to meet the following 3 criterias:

• You need to be aged 65 or older

• You are diagnosed with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS) if aged 65 or below.

• You or your spouse paid Medicare taxes while working for at least 40 quarters (approximately 10 years).

Medicare Part B

This plan provides coverage for a variety of essential outpatient healthcare services that include the following:

1. Doctor visits

   This covers the costs of visiting physicians, specialists, and other healthcare providers.

2. Preventive services

   Part B offers preventive care services vaccinations, screenings, and annual wellness visits.

3. Durable medical equipment

   It offers movement convenience to seniors by offering wheelchairs, walkers, and oxygen equipment that are categorized under durable medical equipment.

4. Home health service

   With this coverage, an individual can access medically necessary services provided at home, such as physical therapy.

What makes you eligible?

The eligibility for Medicare Part B is generally based on your eligibility for Medicare Part A. However, most beneficiaries must pay a monthly premium for Part B coverage.

How to qualify for Medicare chairlift coverage?

Another aspect of Medicare coverage relates to durable medical equipment as discussed above. It is inclusive of wheelchairs, walkers, and oxygen equipment. But most of the seniors who want to navigate around their house easily, need a chairlift. Is it covered under Medicare coverage?

The answer is YES! Medicare Part B helps cover some of the costs of a lift chair when they are deemed to be medically necessary. These devices are essential for individuals with mobility issues and keep them independent without expecting someone’s help.

Here’s what you need to know about Medicare chairlift coverage and its eligibility:

• You need a prescription from a certified healthcare provider who has prescribed a chairlift as medically essential to perform day-to-day activities within your household.

• Your chairlift must be classified as durable medical equipment covered under Part B.

• Under the Medicare chairlift coverage, you can get financial aid for a lifting device and it doesn’t include fabric, cushions, or additional accessories like heat foam or massage pads.

Medicare Part C - The Medicare Advantage Plan

This is one of the parts of Medicare that is gaining attention these days particularly due to an alternative way to receive Medicare benefits through private insurance plans. Under this, you enroll yourself into a private insurance plan approved by Medicare instead of receiving benefits directly from the government.

The answer is YES! Medicare Part B helps cover some of the costs of a lift chair.

How does a Medicare Advantage plan work?

If you have enrolled yourself into a Part C program, then you just got luckier as you get to access additional benefits apart from the original Medicare plan. According to the 2021 study in the Journal of the American Medical Association, individuals who have enrolled in an Advantage plan receive more preventive care than those in traditional Medicare.

On the contrary, if you have enrolled yourself in an original Medicare, you can see any provider but a Medicare Advantage plan requires you to access care from a limited network of providers that you get to choose. We recommend that you choose the one that fits your current healthcare needs.

Medicare Part D - What’s in it?

This part is all about Prescription drugs, which is a fundamental part of healthcare, mainly for those seniors who are dealing with chronic conditions or acute illness. Part D in Medicare was introduced so that seniors can have access to the necessary medications they need.

Eligibility requirements for Medicare Part D

Eligibility for Part D is different from that of Part A and Part B. Part D is available to anyone with Medicare, whether you have Original Medicare or a Medicare Advantage plan.

8 steps to choose a Medicare Part D plan

Are you wondering how to choose a Medicare Part D plan that works best for you? Let us help you with 8 brief steps in choosing the right plan and ensure that you have access to all the medications you need while managing your healthcare budget effectively.

Step 1: Review your medications

Take all the medications you have currently and make a list including dosages and quantities. Make sure you don’t miss any. This helps you in calculating what medications are covered in your Part D plans and lets you choose accordingly.

Step 2: Compare plans annually

Medicare Part D changes annually based on different networks of pharmacies, and their costs. Hence, it is essential that you review your options annually even if you are satisfied with your plan. New available plans might have some more options and existing ones might differ in terms of their formularies and costs.

Step 3: Consider total costs

While monthly premiums of Part D must be taken into account, it is equally important to consider costs like deductibles, copayments, and coinsurance. These factors play an important role in determining the annual costs based on your medication.

Step 4: Network pharmacies

Make sure to check that your preferred pharmacies are in the plan’s network. When you opt for in-network pharmacies, it helps in lowering your out-of-pocket expenses.

Step 5: Formulary coverage

Formulary includes the list of covered medications. Review each plan’s formulary and cross-check if the drugs you need are on the formulary. It is essential that you understand any restrictions or requirements that exist while obtaining your drugs.

Step 6: Coverage gap

A coverage gap is also known as a donut hole, and it affects your drug costs. Certain plans offer coverage within the gap for specific medications, so explore this aspect when comparing plans.

Step 7: Check for financial assistance

Find out if you are eligible to receive any financial assistance programs, such as extra help or state pharmaceutical assistance programs. These programs can help lower your prescription drug costs.

Step 8: Get expert advice

We advise you to consult with a Medicare counselor or an insurance agent who can provide personalized assistance, help in exploring different options, and guide you in choosing a plan that fits your needs.

Medicare coverage gap - What is a Donut Hole?

They often phrase the term Medicare coverage gap as a donut hole wherein you may be required to pay more for your medications once you have spent a certain amount for the covered drugs from your drug plan.

• This Medicare coverage gap doesn’t occur to everyone and applies to only those individuals who reach a certain threshold. In 2023, once you spend $4460 on covered drugs, you enter the Medicare coverage gap.

• After you enter this coverage gap, you’re required to pay a higher percentage of your prescription drug costs.

Here are 3 ways to avoid the Donut Hole:

1. Get a generic prescription

   Most of the common brand name medications have generic alternatives available, and they are less expensive than the common brands, having similar ingredients, dosage, administration, and effectiveness

2. Order medications in advance via mail

   Some Part D drug plans offer discounts as you’re placing the order by mail. This is offered when you order a three-month supply of medications as opposed to obtaining a 30-day supply from a local pharmacy.

3. Seek help from State Assistance programs

   If you meet the income and asset criteria, you may qualify for the Extra Help program (Low-Income Subsidy program), which offers financial assistance for Medicare Part D costs.

If you meet the income and asset criteria, you may qualify for the Extra Help program (Low-Income Subsidy program), which offers financial assistance for Medicare Part D costs.

To wrap it up,

Medicare is essential for all individuals who require proactive medical attention to continue leading a quality and healthy lifestyle. It acts as a safety net by providing essential healthcare services, hospital care, and prescription medications. Our main goal in this blog was to impart the knowledge of different facilities offered in each part of Medicare so that you can make a sound decision about your healthcare coverage.

We advise you to feel free and seek expert guidance whenever you need it during your healthcare needs so that you do deviate from the right path. Once you come to the end of the blog, we hope that you will be able to deal with Medicare challenges with clarity, and confidence.

Learn more about Medicare benefits here.

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