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Medicare is a health insurance plan funded and administered by the Federal Government. Individuals age 65 and older are eligible for Medicare regardless of their income or asset levels. Medicare may also be available for individuals younger than 65 if they have qualifying disabilities or end-stage renal disease. Medicare is broken into four parts (A, B, C, and D), each covering different items and requiring different premiums. The four different parts are explained below. For further information on Medicare, visit www.Medicare.gov.
Medicare Part A is the "hospitalization" portion of Medicare. Part A covers inpatient hospital care, short-term nursing and rehabilitation stays in a nursing facility, home health care, and hospice. Most individuals are automatically enrolled in Part A when they turn 65. Some people must voluntarily enroll and pay a premium if they have not met the lifetime payroll tax requirements. Part A covered inpatient care may require a deductible and/or copay by the beneficiary.
Medicare Part B is the "supplemental medical insurance" portion of Medicare. Part B covers physician services, outpatient radiology and laboratory services, therapy, medically necessary ambulance transport, certain supplies and equipment, and a few other services not covered by Part A. Part B does not cover most outpatient medications. Part B is a voluntary program that requires eligible individuals to enroll and pay a monthly premium. Most people with Part A choose to enroll in Part B as Part A and Part B are designed to provide a comprehensive health plan when used together.
Medicare Part C is also known as Medicare Advantage. Medicare Part C plans may occasionally be referred to as Medicare HMOs or Medicare PPOs. Medicare Part C plans are administered by private insurers and health care organizations rather than the Federal Government. An individual may choose to enroll within a Medicare Part C plan in lieu of Medicare Part A and Part B. The Medicare Part C plan must provide inpatient and outpatient benefits equal to or greater than the combined benefits of Medicare Part A and Part B, including short-term nursing and rehabilitation. A premium is paid to the Part C plan rather than Part B. Deductibles and copays may apply. Some Part C plans allow enrollees to use any Medicare contracted provider while other Part C plans restrict provider choice to a limited panel.
Medicare Part D is the Medicare Prescription Drug Plan. Part D covers outpatient prescription drugs. Part A only covers drugs provided during an inpatient hospital or short-term nursing and rehabilitation stay. Part D is administered through private insurance companies. A Medicare beneficiary must select and enroll in a Part D plan. Premiums and/or deductibles and copays apply to most Part D plans.
MediGap insurance plans may be purchased through private insurers to cover the expense of meeting the deductibles and copays of Medicare Part A, Part B, and/or Part D. Some MediGap plans also cover certain items that are not covered by Medicare.
Medicare Part A or B does not cover extended or long-term care stays in a nursing facility, assisted living facility or independent living center. Nor do they cover specific services such as private duty nursing, most chiropractic services, dental care, optometry services or general transportation for doctor visits.