Confused about Medicare Coverage? Part A, Part B, Part C Part D?

Traditional Medicare which every American who qualifies signs up for at 65 or earlier if qualifying conditions are met, includes parts A&B. Part A covers hospitalization and Part B covers doctors visits and other health provider care and durable appliances. So what is Part C?

Part C is now known as a Medicare Advantage Plan (MA) ? So, what’s the difference? Medicare is provided and run by the government and connected to Social Security in terms of qualifications. Medicare Advantage Plans are sold by private insurance companies and must contain all the coverage that traditional Medicare provides.

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  • So why would I want a Medicare Advantage Plan?

    The major reason for people to choose an MA plan is for the additional benefits that many of them offer. Traditional Medicare has no provision for hearing, only limited vision coverage for vision and nothing at all for dental. All of these, vision, dental and hearing may be a benefit of a Medicare Advantage Plan.

  • Okay, Part D? What’s That?

    The other part, D is for prescriptions. Aside from medications in hospital or physician provided m office medications there is no coverage for prescriptions in traditional Medicare. So you must purchase a separate plan to cover any prescriptions filled for you by a pharmacy. There are separate part D plans available, but since they are generally part of an Advantage Plan it is another obvious benefit.

  • Are there any disadvantages?

    Cost can be a factor, though some Advantage Plan do not charge a premium, they may have co pays for each provider visit, deductibles that must be met and out of pocket limits which may be high.


What types of Medicare Advantage Plans are available?

  • HMO- Health Maintenance Organization focuses on preventative care and requires a primary care physician through whom all requests to see specialists must be approved. Service outside the network is discouraged. Make sure the network includes your doctor and hospital.
  • PPO-Preferred Provider Organizationis a network of providers much like an HMO, there is no primary care physician required to see specialists and out of network physicians can be used at additional cost. Finding a PPO that includes your physicians and hospital will help control costs.
  • PFFS-Private Fee For Service plans are a network of health care providers who have agreed with the insurance company to accept an agreed upon fee/ Not all doctors accept this kind of coverage.
  • SNP-Special Network Providers- A network of providers that is established to provide physicians,hospital services and drugs to patients with a specific need.

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