What is Medicare Part...?

To answer the question, what is medicare part…? Well, there are many different parts to medicare. Also, a lot of confusion. Let’s take a look at this subject one at a time.

First let’s get a foundation with the Center of Medicare and Medicaid Services (CMS). This government organization is responsible for all standards and regulation. If you know anything about sports, CMS would be the referees.

What is Medicare Part A?

It is designed to cover inpatient care provided in hospital settings, as well as skilled nursing facility, home health care, blood and hospice.

What is Medicare Part B?

It is designed to cover outpatient care provided in doctor settings, as well as durable medical equipment and preventative services.

What is Medicare Part D?

Also called (PDP) is governed (refereed) by CMS rules and regulation but designed by private insurance companies. It covers approved medications under formulary (a list of covered prescription drugs) and contracted pharmacies. Diabetic supplies like insulin, lancets test strips and syringes are covered. Under Medicare Part D CMS set coverage rules regarding transition process, prior authorization, step therapy, quantity limits, medication management and therapy (MTM) just to name a few.

I know Part D is going to look out of place, but it’s intentional. What is listed above is the minimal most people need to keep from being penalized for late enrollment. Check out the video below.

What is Medicare Part C?

In most cases are hybrid plans governed by CMS, but designed by private insurance companies. Part C is also called Medicare Advantage Plans. These plans combines (bundle) Part A, B and most of the time D together and works somewhat the some except for the 20%.

What are Supplements (MediGap)?

This is the one part that does what it sounds like it would, cover the gaps not covered by medicare. The 20%, deductibles, co-insurance, etc. Under supplements, there are 11 different plans not parts from A through M with different deductibles, copayments but no drug coverage (PDP). Also, no referrals needed, no provider networks and a lot of value added services above original medicare services.