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About Medicare Parts A, B, C and D (and Medigap)

Have you learned your A B C D's

Overview                                                                                           printer friendly

Medicare is a federal health insurance program. It covers most people age 65 or older, some people younger than 65 with disabilities, and people with end-stage renal disease, often referred to as ESRD.

Medicare does not provide complete coverage for all health care needs. Even though it pays for some preventive services and covers most medically necessary services, Medicare doesn't pay for many routine services like annual physicals, or things like glasses, hearing aids, or long term care at home or in a nursing home.

Medicare Parts A, B, C and D

Medicare is divided into four parts: Part A, Part B, Part C and Part D.

Part A: Hospital Insurance

Part A pays for most inpatient hospital care, some inpatient skilled nursing home care, some home health care, and hospice care. You are automatically enrolled in Part A when you join Medicare. If you qualify automatically for Medicare (through your own or your spouse's Social Security record), you do not have to pay a monthly premium for Part A coverage.

If you have 30-39 Medicare-covered employment quarters, you may buy Part A for $216 per month (2006). If you have fewer than 30 quarters, you may purchase Part A for $393 per month (2006).

Part B: Medical Insurance

Part B pays for doctors' services, outpatient hospital care, outpatient physical and speech therapy, some home health care, ambulance services, and some medical equipment and supplies.

Part B coverage is voluntary. The monthly premium ($93.50 in 2007) is automatically deducted from your Social Security check every month. If you don't receive Social Security benefits, you will be billed for Part B.

Medicare Part C: Medicare Advantage Plans

Part C governs the way Medicare benefits are provided by companies that contract with the Medicare program. Someone with Medicare who enrolls in a Medicare Advantage plan generally gets all of their medical services through that plan. Health Maintenance Organizations (HMO's) and Preferred Provider Organizations (PPOs) contract with Medicare to provide Medicare benefits in a managed care setting, that in 2006 will include the new Medicare Part D benefit in all but a few HMOs. Private Fee for Service plans (PFFS) and Medical Savings Accounts (MSAs) can contract with Medicare to provide Part A and B benefits through an insurance program. PFFS plans have the option of including the new Part D benefit while MSA plans are not allowed to. People enrolling in one of those plans without Part D benefits would need to buy separate coverage for that benefit.

Part D: Medicare Prescription Drug Coverage

Since 2006, Medicare Part D offers some help with prescription drugs. The coverage is voluntary, handled by private insurance companies, and the monthly premium varies depending on how much coverage you have. You can get the part D benefit in a policy that is considered a "stand alone" (covers only drugs), or in a Medicare Advantage plan which incorporates Medicare Pats A, B, and D in one policy (and is sometimes called Medicare Part C).. For a more complete description of Part D, as well as other prescription drug  information and links, see, SeniorArk Main Medicare Page, Charts,  Fiasco, and the Donut Hole. You might also like to read : Medicare Part D Simple Explanation.

Medigap: http://www.medicare.gov/medigap/default.asp (Also called "supplemental insurance") Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium. In addition, you will have to pay a premium to the Medigap insurance company. A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will pay both their shares of covered health care costs.