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What is Medicare?

Medicare is the United States’ federal health insurance program for people who are 65 or older. It is also available for certain people younger than 65 with disabilities or people with End-Stage Renal Disease. 

There are several “parts” to Medicare that contain different coverage.

Most people are familiar with "Part A" and "Part B", which are a part of Original Medicare. Medicare also includes "Part C" and "Part D". 

What is Medicare Part A?

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. 

Most of the time Part A does not cost a penny.

  • Inpatient hospital care: This includes all care you receive after being admitted into a hospital by a physician. Medicare covers up to 90 days each benefit period in a general hospital. In addition, you receive 60 lifetime reserve days. It also covers up to 190 lifetime days in a Medicare-certified psychiatric hospital. 

  • Skilled nursing facility care: Medicare covers your room, board, and certain services provided in a skilled nursing facility. This includes medications, tube feedings, and wound care. It covers up to 100 days each benefit period. To qualify, you must have spent at least three consecutive days in the hospital within 30 days of admission to a skilled nursing facility and must have needed skilled nursing or therapy services. 

  • Home health care: Though it is normally covered by Part B, Part A coverage will kick in if you have spent at least three consecutive days as a hospital inpatient within 14 days of receiving home care. Up to 100 days of daily care are covered or an unlimited amount of intermittent care.

  • Hospice care: Hospice care is covered for as long as your provider certifies it is necessary. 

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What is Medicare Part B?

Medicare Part B is outpatient medical coverage. Part B helps pay for medically necessary services performed on an outpatient basis that are needed to diagnose and treat a medical condition.

Surgeries, lab work, and preventative services are all covered under Part B.

  • Provider services: Services deemed medically necessary are covered under Part B.

  • Durable medical equipment: Equipment that serves a medical purpose, able to withstand repeated use, and appropriate for home use, is covered. For example, diabetic supplies.

  • Home health services: If you are home-bound and need skilled nursing or therapy care, you’re covered under Part B.

  • Ambulance services: Emergency transportation by ambulance. Limited coverage for non-emergency transportation is available in which there is no safe alternative as long as it is medically necessary. 

  • Preventative services: Outpatient physical, speech, and occupational therapy services are covered as long as they are administered by a Medicare-certified therapist. 

  • X-rays and lab tests: All doctor ordered x-rays and lab tests are covered.

  • Chiropractic care: Only when medically necessary to fix subluxation of the spine.

  • Certain prescription drugs: Certain drugs such as immunosuppressants, select anti-cancer, select antiemetic, select dialysis, and other typical drugs administered by a physician.

What is Medicare Part C?

Medicare Part C is also called Medicare Advantage (MA). It’s an alternative benefit to Original Medicare. Medicare Advantage may include prescription drug coverage, along with other extra benefits that Original Medicare does not cover such as:

  • Dental coverage

  • Vision coverage

  • Caregiver Counseling and Training

  • Housekeeping

  • Prescription Drug Coverage

It is offered through private insurance companies, so you don’t enroll in it at the Social Security office or website. To enroll in Medicare Part C, you can work with an experience broker, like the Medicare Policy Experts.

What is Medicare Part D?

Medicare Part D is also known as prescription drug coverage. Part D coverage is available as a stand alone Prescription Drug Plan (PDP) or as part of a Medicare Advantage plan (Part C).


Part D plans are offered by private insurance companies contracted and approved by Medicare.

Each Part D plan has a list of covered drugs called a formulary. If the drug you need is not on the formulary, you are allowed to request an exception, pay out of pocket, or file an appeal. 

These formularies differ from plan to plan so be sure to request a copy. However, each plan must cover all drugs in the following categories: 

  • HIV/AIDS treatment 

  • Antidepressants

  • Antipsychotic medications

  • Anticonvulsive treatments for seizure disorders

  • Immunosuppressants

  • Anticancer drugs (unless they are being covered under Part B)

Most vaccines are also covered under Part D unless they are already covered under Part B.

What are Medicare Supplements?

Medicare Supplement plans, also called Medigap plans, are designed to work with Original Medicare Parts A and B. Medigap policies help pay for some health care costs not covered by Original Medicare, such as deductibles, coinsurance and foreign travel emergency.

These plans are offered by private insurance companies and are available to people with Medicare Part A and B. 

People with Original Medicare and a Medicare supplement can choose any stand-alone Part D prescription plans to pay for their drugs.

People who are enrolled in Medicare Advantage plans (Part C) are not eligible for a Medicare Supplement insurance policy.

Need Help Deciding Which Coverage is Right for You?

Do you still need help deciding which coverage is right for you? Give us a call at 816-608-6100 or request your free consultation using the button below!

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