The Driving Parts of Medicare
The Driving Parts of Medicare
Do you know the different parts that drive the Medicare program? Each part of Medicare covers different health services such as hospital care, doctor services and prescription drugs. AARP’s Medicare Question and Answer Tool is a starting point to guide you. Medicare Getting Started
Q: A: Medicare has four parts, each offering a different type of coverage: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage) and Part D (prescription drug coverage). — Q: A: Original Medicare is a fee-for-service health program. This means that you can choose any doctor or hospital that accepts Medicare patients, anywhere in the United States, and Medicare will pay its share of the bill. — Q: A: The original Medicare program consists of Part A and Part B. If you’re enrolled in original Medicare and want Part D prescription drug coverage, you must actively choose and join a Part D drug plan. But which type of insurance you choose, and when you enroll, depends on your own circumstances. — Q: A: Yes. Medicare has covered outpatient prescription drugs ever since the Part D drug benefit came into effect in 2006. — Part A Hospital Insurance
Q: A: Medicare Part A helps pay for inpatient stays in the hospital or a short-term skilled nursing facility, for home health services and hospice care. You don’t pay premiums for Part A if you or your spouse paid enough Medicare payroll taxes while working. — Q: A: Medicare Part A covers many hospital costs but not all. — Part B Medical Insurance
A: Medicare Part B covers doctors’ services, outpatient care, and medical equipment and supplies. — Q: A: Medicare Part B covers a very wide range of medical services, but there are gaps. — Part D Prescription Drug Coverage
Q: A: Part D is insurance that helps reduce the cost of prescription drugs that you take yourself. — Q: A: Yes. There is no single source of Medicare prescription drug coverage. You must get it either through a Part D “stand-alone” plan or through a Medicare Advantage health plan that offers both medical and drug benefits. — Q: A: You need to choose a drug plan according to the specific prescription drugs that you take. — Q: A: No, you can’t be enrolled in more than one Part D plan at the same time. But, if you want to, you can switch to a different plan at certain times. — Q: A: Yes, you have many choices in how your receive health and drug benefits from Medicare. — Q: A: No Part D drug plan covers all prescription drugs. But each plan must make available the list of drugs it covers (known as a formulary). — Q: A: The best way of finding out which Part D plans cover the prescription drugs you take is to use the online Medicare plan finder program — either yourself or by getting somebody else to use it for you. — Q: A: A formulary is the list of prescription drugs that a Medicare Part D drug plan covers. — Q: A: There are several possible explanations for a Part D plan not immediately providing coverage for a drug that it normally covers. Usually it means that the plan has set a “restriction” on your drug. — Q: A: Whether you can fill prescriptions in other parts of the nation depends on whether the Part D plan you enroll in offers national coverage. — Q: A: No, there is no limit to the number of prescriptions that you can fill under your Part D plan. But no plan covers all drugs, and plans may limit the quantity of drugs filled under a single prescription in some situations. Also, Medicare excludes some types of drugs from Part D coverage. — What Medicare Does and Does Not Cover
Q: A: Medicare covers some health care services provided in your own home, at no charge to you, but only if you meet certain conditions. — Q: A: You can find a Medicare-approved home health agency in the Home Health Compare section of www.medicare.gov. — Q: A: Medicare does not cover long-term care. But it covers short-term stays in skilled nursing facilities in certain circumstances. — Q: A: Medicare covers 100 percent of the cost of hospice services for terminally ill people who meet certain conditions. — Q: A: The original Medicare program does not cover routine hearing care, although some Medicare Advantage plans cover it as an extra benefit. In both cases, coverage is provided for hearing treatment that Medicare considers medically necessary. — Q: A: The original Medicare program does not pay for routine vision care, although some Medicare Advantage plans cover this cost as an extra benefit. In both cases, though, coverage is provided for eye treatment that Medicare considers medically necessary. — Q: A: The original Medicare program does not cover routine dental care, although some Medicare Advantage plans cover it as an extra benefit. In both cases, coverage is provided for dental treatment that Medicare considers medically necessary. — Q: A: Medicare does not cover routine foot care but does cover medically necessary podiatric tests and services to diagnose or treat foot injuries or diseases. — Q: A: Medicare pays for some chiropractic services but not others. — Q: A: Medicare covers a wide range of medical equipment and supplies — all of which must be medically necessary — but not everything. — Q: A: Medicare helps people who want to quit smoking tobacco in two ways — by providing coverage for counseling and prescribed medications. — Q: A: Yes, Medicare covers the pneumonia vaccine under the Part B benefit. — Q: A: Yes, Medicare pays for one flu shot in each flu season, which runs from November through April. — Q: A: Medicare covers the shingles vaccine but only through Part D prescription drug plans. — Q: A: No, Medicare does not pay for routine physical exams. But it does cover an annual “wellness visit” that is intended to keep track of your health. — Q: A: The “Welcome to Medicare” checkup is an optional one-time opportunity for a doctor to assess your health when you first enter the Medicare program, free of charge. It serves as a baseline for monitoring your health in future years. — A: Bring a list of your medical records, family health history and a list of the medications you take. — Q: A: Medicare’s annual wellness visit is a free preventive benefit that allows a doctor to monitor your health on a yearly basis. — Q: A: Medicare covers colonoscopy screening free of charge if certain conditions are met, but you would pay a share of the cost for additional treatment. — Q: A: Medicare makes no charge for a wide range of tests, screenings and services that help detect and prevent or stave off some of the diseases that make people very ill. — Today' s Topics
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