Medicare Part A and B: Understanding the ABCs of Medicare

Medicare coverage can be confusing and intimidating to many individuals who are close to retirement age. Many fail to understand the difference between Medicare Part A and B coverage and, while Part D is widely known as the prescription drug benefit, Part C plans are less well understood. In order to select the best plan to serve specific medical needs, it is essential to understand the different plans and how they work together to provide comprehensive coverage for Medicare recipients.

Medicare Part A is also known as basic Medicare; it provides catastrophic medical insurance for hospital stays and skilled nursing facilities. Part B coverage provides benefits for routine doctor’s visits, examinations, and testing on an outpatient basis; combined, Medicare Part A and B provide a fairly comprehensive level of coverage for most recipients with the exception of prescription drug coverage. Medicare Part D offers coverage for a wide range of medications, and is a valuable addition for most Medicare members.

Medicare Part C is different from the other options discussed because it is provided by private insurance companies rather than through the government directly. Part C combines Medicare Part A and B coverage, and usually requires that members receive care through a preferred provider network. Most Part C plans include prescription drug coverage; by law, these plans must provide the same benefits as the Medicare Part A and B plans directly offered by the government. Generally, Part C plans offer slightly better coverage and are more useful for individuals who expect to need repeated doctor visits or tests throughout the year. By obtaining their health care through the private insurance company’s network of physicians and providers, the costs of treatment can be reduced. In most cases the company passes along this savings to its members.

In some instances maintaining regular Medicare coverage is preferable to Part C enrollment. Some patients will not qualify for Part C coverage due to pre-existing End-Stage Renal Disease; additionally, members must already be enrolled in Medicare Part A and B before enrolling in Part C coverage. Part C plans vary widely depending on the company and monthly premiums can vary as well; comparing plans and premiums is the best way to determine which Part C plan is right for you.