Home Health & Wellness Medicare Parts Guide

Medicare Parts Guide

Published: Last updated:
Reading Time: 3 minutes

Medicare is a health insurance programme for seniors and people with some disabilities. It provides medical care for all eligible US citizens. Medicare has many parts that work together to provide health insurance. Each part covers a different set of medical services. Most Medicare parts are funded directly by taxes and fees, while the federal government supports the others.

Here is a list of all Medicare Parts.

Medicare Part A

This part pays for inpatient hospital stays and care unrelated to your stay in the hospital. Medicare Part A does not pay for routine checkups, vaccinations, and annual wellness exams irrelevant to one’s eligibility for Social Security or Supplemental Security Income (SSI) benefits. These include doctor’s visits, hospital care, certain home health services, and some types of durable medical equipment (DME). It also covers ambulatory rehab services in hospitals. A hefty deductible is required for Part A services. The deductible is the same as the Medicare Part B deductible, which is $1,186 for a person. For a family with two or more people in it, this amount increases to $2,210 per year. The maximum amount of time you must wait before paying your deductible amounts is 90 calendar days (or 364 days if you are hospitalized).

Medicare Part B

This Medicare part covers oral surgery and other medical services not covered by Part A. There is no deductible for Medicare Part B. You only pay 20% after you have incurred the yearly ‘out-of-pocket amount of $1,016 for an individual or $1,944 for a couple within a calendar year. Another way Medicare Part B works is through copayments, coinsurance, and deductibles. It means that you pay specific amounts for your medical services based on how much the service costs.

Medicare Part C

The plans offered through a Part C program are known as Medicare Advantage Plans or MA Plans. Medicare Advantage Plans do not receive federal funding and provide health insurance instead of paying directly for services out-of-pocket. They are complementary to the traditional Medicare Parts A and B. Medicare Advantage plan funded through the United States Social Security Administration. To accept a patient, the doctor must have agreed to participate in Medicare and be accepted by Medicare’s approved list of providers. It is one of the more costly aspects of Medicare, though it helps pay for doctor’s visits, outpatient care, and many other services. This section allows you to pay the costs not covered by Part A. Part B includes a monthly premium. This premium is $104.90 per month for most people with this coverage, with a quarterly deductible of $164.

Medicare Part D

It is designed to help pay for brand-name and generic prescription drugs, but not over-the-counter medications. It is also not meant to cover medical tests needed to get a prescription. You will need a prescription from a United States licensed physician to receive Medicare Part D. The only exceptions are in the case of emergency or preventative care services (screenings). Private companies approved by Medicare administer part D plans. The Social Security Administration contracts with these companies, and each company is responsible for different parts of the country.

How Medicare works

The federal government helps the Medicare program to operate by making sure it operates efficiently and effectively. It also oversees how much Medicare will pay doctors and other healthcare professionals and how much they will reimburse health insurance companies. The Social Security Administration (SSA) receives matching payments from the Medicare Trust Fund to help pay for Part B and Part D coverage. Medicare insurance pays for physician services, skilled nursing facility care, home health care, and other services in hospitals, skilled nursing facilities, and home health agencies.

Who is eligible for Medicare?

To be eligible for this programme, the patient must have been a citizen of the US or a non-citizen that has filed to become a permanent resident. You also must meet specific other requirements. You must be older than 65 years old or have been disabled for at least one year before becoming eligible for Part A or Part B. You must have lived in the United States for at least five years as of December 31 of the year you are enrolling. Receive Social Security Disability Insurance benefits for at least one year. It is also important to note that you cannot be in the Medicare insurance program when receiving Social Security Disability Insurance payments, or you will have to stop your payments at once. Have amyotrophic lateral sclerosis (ALS) that is presumed to be progressive, and you have been diagnosed with the condition before receiving Social Security disability benefits. This means you must have a physician diagnose your illness, or have your disability adjudicated before you become eligible for Part B.

Final thoughts

Medicare is one of the most significant parts of the federal government, helping millions of people reach their goals and dreams. Medicare was created as part of LBJ’s Great Society program. It spends billions of dollars on healthcare every year. Medicare is a vast and crucial part of the Social Security System.

Ellen Diamond did her degree in psychology at the University of Hertfordshire. She is interested in mental health, wellness, and lifestyle.

© Copyright 2014–2034 Psychreg Ltd