I often ask a patient with a Medicare Advantage Plan what Insurance they have. They will tell me something like “Medicare” or “Aetna” when in fact they truly don’t know what they have. Their answers always tell me what I need to know; this patient doesn’t understand their insurance plan or know what their plan is.
In this first of several Blogs, I am going to discuss the parts of Medicare and then what a Medicare Advantage Plan is. In later posts, I’ll be getting into some of the finer nuances of the plans and cover what your insurance agents may not tell you but you should definitely know.
Medicare has four parts as outlined below.
Medicare Part A is one part of the Medicare program. This part of Medicare primarily covers your stay in a hospital or other inpatient services. This includes the following:
-Inpatient Hospital stays inclusive of your room, meals, medications adminstered during your stay, and any services you receive during your stay, such as MRIs or CT scans.
-Skilled Nursing Facility (SNF) after a qualified stay in a hospital. This usually means three days in a hospital before a transfer to a SNF. This includes your nursing care, medications administered during your stay, and rehabilitation services.
-Home Health Care after a hospital stay. This includes skilled nursing, speech therapy, physical therapy, occupational therapy, up to 100 visits after you have been hospitalized.
-Hospice Care for those who are expected to live less than 6 months or are terminally ill. This usually covers things like pain relief, medical, nursing and social services, and grief counseling for family members.
Medicare Part B is another part of the Medicare Program. This primarily covers your outpatient services.
-Doctor visits
-Diagnostic imaging like MRIs and CT scans
-Outpatient procedures and surgeries
-Wellness visits
-Durable medical equipment like wheelchairs and walkers
-Laboratory testing
-Preventive care and screening
-Mental health services like psychiatric evaluation and medication management
-Ambulance services.
Medicare Part C is Medicare Advantage Plans.
A Medicare Advantage Plan is an alternative to traditional Medicare (Part A and Part B) provided by private insurance companies approved by Medicare. These plans propose to offer coverage for all services provided under original Medicare, and often proclaim additional benefits and services not covered by traditional Medicare
Medicare Part D is the portion of Medicare that provides coverage for prescription medications. These drugs have been vetted and approved by Medicare. You can enroll in standalone Medicare Part D if you have part A and B, or it may be included in a Medicare Advantage Plan. Part D plans have tiers of drug coverage and not all are covered. You will want to check your medications list against the Part D formulary to see if your medications are covered. These Part D plans usually have:
-Monthly premiums
-Deductibles
-Copays/Coinsurance
-Catastrophic coverage wherein you’ll pay significantly less on your medications once you have reached a certain out-of-pocket limit
-Network pharmacies that offer the best pricing
Check back soon for my next discussion on Medicare vs Medicare Advantage Plans!
David Biesinger, DPM, D.ABFAS, FACFAS