What are the four types of Medicare?

Medicare Supplement plans 2020In general, different parts of Medicare can help you meet certain services. Most beneficiaries choose to receive the benefits of Part A and B through Original Medicare, a traditional service fee program offered directly by the federal government and also called traditional Medicare or Fee-for-Service (FFS) Medicare. According to the original Medicare, the government pays directly for the medical services received.

In the Original Medicare Plan:

  • You can go directly to your doctor or hospital when care is needed. No prior approval/permission from Medicare or your doctor is required.
  • Responsible for the monthly premium of Part B, and some may also pay for the Part A premium.
  • You are usually must pay coinsurance for each service you receive.
  • There is an amount of limitation that a doctor or hospital may require for your treatment.

If you want to cover your prescription medicines plan with Original Medicare, you will probably need to join an independent Medicare Private Drug Plan (PDP).

Unless you choose another method from you will have the Original Medicare. Instead of the Original Medicare, you can benefit from Medicare’s Medicare Advantage Plan, also called Part C or Medicare Private Health Plan. Please keep that in mind that if you sign up for the Medicare Advantage Plan, you will continue to use Medicare. It means that you will still have to pay a monthly Part B premium (and Part A premium, if applicable). Each Medicare Advantage Plan should provide all Part A and B services covered by the original Medicare. Still, they may differ due to expenses, restrictions, applicable rules that can or may affects how and when they take care of you.

It is important to understand Medicare coverage options and carefully select the one coverage you will be needing. How you choose benefits and who benefits from you depends on how much you will pay and where you can receive care from. For example, with Original Medicare, you can go to almost every doctor and hospital in the country available. On the other hand, Medicare Advantage plans often have network limitations. It means that doctors and hospital choices will be limited in this case. However, the Medicare Advantage Plan has additional benefits that are not necessarily covered by Original Medicare, such as routine vision and dental care.

Medicare Part A

Medicare Part A intended for the following services:

  • Inpatient hospital treatment: This is the care that a doctor performs after official hospitalization performed formally. In a typical hospital, in addition to a maximum of 90 days, each benefit has 60-day lifetime reserve days. Medicare also offers up to 190 lifetime days of service at Medicare-certified psychiatric hospitals.
  • Skilled Nursing Facility (SNF) Care: Medicare includes the rooms, meals, and a various number of services provided by SNF, including medication administration, tube feeding, and wound care management. If eligible for coverage, you can qualify for up to 100 days per benefit period. To qualify, you must spend at least three consecutive days as an inpatient within 30 days of admission to SNF and require skilled nursing or treatment services.
  • Home Treatment Care: If you are doing home health care and need qualified care, Medicare covers the service at your home. You are entitled to everyday care up to 100 days or extensive intermediate treatment. To qualify for Part A, you must be in the hospital for at least three consecutive days within 14 days of receiving home care. (Note: If you do not fulfil all the requirements of Part A coverage, you can get home care from Medicare Part B).
  • Nursing Home Care: This is the type of care that health care professionals allow you to receive if they detect end-stage disease. As long as the provider confirms that they need to be careful, covered by the insurance. Keep in mind that Medicare typically does not cover the full cost of care and responsibly bears a portion of the cost-sharing (deductibles, coinsurances, copayments) for services covered by Medicare.

Medicare Part B

Medicare Part B offers outpatient/health insurance. The following list provides an overview of Part B’s target services and rules of coverage.

  • Supplier services: Medically necessary services from a qualified medical professional.
  • Durable Medical Equipment (DME): It is useful equipment for medical purposes, and can withstand repeated use and is suitable for home use. Examples include pedestrians, wheelchairs and oxygen depots. You can purchase or rent DME from a Medicare-certified supplier after your provider has obtained the required certificate of you needing them.
  • Medical Services at Home: These services are covered when you are qualified for home care and in need of a professional nursing provider, or therapeutic care is required.
  • Ambulance Service: This is usually an emergency means of transport to and from the hospital. Non-ambulance / ambulance transport is limited to situations where safe alternatives are not available and where traffic is medically necessary for the patient.
  • Prevention Services: These are multiple screening sessions and counselling seminars to prevent diseases, determine conditions and protect your health, above everything else. In most cases, preventive care provided and covered by Medicare without coinsurance.
  • Therapy Services: These are outpatient physiotherapy, speech therapy and occupational therapy services provided by Medicare-certified therapists.
  • Mental health services.
  • X-ray and laboratory test.
  • Chiropractic care: When you are medically in need of the fixation of the subluxation of the spine during spinal manipulation. (when one or more bones of the spine are dislocated)
  • Choose Prescription Medications, including immunosuppressive drugs, some anti-cancer drugs, some antiemetics. Some dialysis drugs, and another type of drugs that are frequently used by doctors.

This list includes services and items that are usually covered, but not a complete list.

Medicare Part C

Medicare Supplement plans 2020Part C, also known as the Medicare Service, is an alternative to traditional Medicare coverage. The coverage usually includes all parts A and B, prescription drug plans (Part D), and other benefits. Part C is managed by a private insurance company that receives Medicare payments from the federal government. Depending on the plan, you may or may not need to pay an additional premium for Part C. You do not need to sign up for an Advantage plan – if you are away from your home country, there are restrictions such as not including health care plan. However, for many people, these plans are a better deal than paying separately to the central regions Part A, B, and D. If you are satisfied with the range of HMO, you may be finding this Part similar.

Medicare Part D

Medicare Part D, which benefits from prescription medicines, is a part of Medicare, which covers most outpatient prescription medicines. Part D offered as a stand-alone plan for those registered with Original Medicare through private companies or as a set of benefits included in the Medicare Advantage plan.

If you do not have reliable drug coverage and will have a particular registration period, you should sign up with Part D when you first purchase Medicare. Delayed registration may create gaps in coverage and registration penalties. Each Part D plan has a list of closed medicines called prescription (formulary). If the drug is not prescribed or available in the formulary, you will need to request an exception, pay through your pocket or request an appeal. A category of drugs is a group of drugs that treat the same symptoms or have similar effects on the body. All plans in Part D should include at least two medications in most categories and include all drugs available in the following class, as mentioned below:

  • HIV / AIDS treatment
  • Anti-depressants
  • Antipsychotic medications
  • Anticonvulsant therapy for epileptic (seizure) disorders
  • Immunosuppressive drugs
  • Anticancer agents (if not covered in Part B)

Part D Plans must include vaccines other than those vaccines that are already covered by Part B. Some medications excluded from Medicare under laws such as weight loss or weight gain, or medicines such as over-the-counter medications (drugs).