The ABC’s (and D’s) of Medicare: What Does It All Mean?
Posted by Daniel Hyman, DO and Bianca Lacay, BSN, RN on January 19, 2018
As the population of the U.S. ages, more people are utilizing Medicare. However, few healthcare providers understand the different parts of Medicare and what it has to offer. Being familiar with the different parts of Medicare will help providers understand the process their Medicare-eligible patients go through to obtain healthcare.
There are four parts to Medicare:
1. Part A is the hospital insurance that covers services like inpatient hospital care, inpatient skilled nursing care, hospice care, and home health care.
2. Part B is the medical insurance that covers services like physician visits, outpatient care, medical equipment, clinical lab, and preventative care.
3. Part C, also known as Medicare Advantage (MA), is a type of plan that is offered by a private insurer to provide the same benefits as the Original Medicare plus more. More information is discussed below.
4. Part D is a supplemental stand-alone prescription plan that can be utilized alone or be combined with the Original Medicare (Part A and Part B combined) to help cover the cost of drugs.
MA plans can include services that are not offered in the Original Medicare such as wellness programs, preventative care, vision, hearing, dental coverage, and medical care abroad. Costs are calculated on a risk score based on documented diagnoses per member per month and out-of-pocket costs have a yearly limit. On the other hand, Original Medicare is fee-for-service. For both Original Medicare and MA, a one-time “Welcome to Medicare” preventative visit and a yearly “Wellness” visit are covered as long as patients have Part B. There is no copay for these visits and deductibles do not apply. Overall, the MA program is Medicare’s move to prevention and population health.
Accountable Care Organizations such as our AllCare Health Alliance serve people with original Medicare by expanding access to care coordination to better manage their health.
For more information, please visit www.medicare.gov.
