Understanding Medicare: An Overview of Sections A Through D
Medicare is a federal health insurance program maintained by the U.S. government that covers millions of Americans. Those over the age of 65 are generally eligible to receive Medicare coverage. Additionally, Medicare coverage should also be issued if Social Security benefits are already in place or criteria for certain disabilities have been met. There are four main components to Medicare coverage that impact what will be included or excluded from each person’s coverage.
The following includes a breakdown of the various Medicare components:
Medicare Part A – Hospital Insurance
On the first day of the month when you turn 65 years old, you are entitled to receive Medicare Part A. In most cases, it is free. You will not pay a premium for Medicare Part A if you or your spouse has paid Medicare taxes for at least 10 years. If you already receive benefits from Social Security or from the Railroad Retirement Board (RRB) you will automatically receive Medicare Part A. If you are not already receiving Social Security benefits (for example, if you are still working), you may still be eligible to receive Part A at no cost, but you may need to sign up to receive these benefits.
The services covered by Medicare Part A include the following:
- Inpatient care in hospitals, such as critical access hospitals, inpatient rehabilitation facilities and long-term care hospitals
- Inpatient care in a skilled nursing facility (not custodial or long-term care)
- Hospice care services
- Home health care services
- Inpatient care in a Religious Nonmedical Health Care Institution
Medicare Part B – Medical Insurance
Medicare Part B is optional coverage that is purchased from the federal government. You are eligible for this coverage once you are over the age of 65. The most common way people pay for Medicare Part B is in the form of a monthly premium that is usually deducted from the Social Security benefit check.
Medicare Part B premium levels vary based on your annual income and are set each year by the Centers for Medicare and Medicaid Services (CMS). If you already receive benefits from Social Security or the Railroad Retirement Board (RRB), it’s possible that you may be automatically enrolled in Part B, effective the first day of the month during which you turn 65. You may also be eligible for Part B if you are disabled or have certain end-stage renal diseases.
The services covered by Medicare Part B include the following:
- Office visits to a primary care physician or a specialist
- Some preventive services, such as flu shots and mammograms
- Laboratory costs, including blood work and X-rays
- Medical equipment, such as wheelchairs and walkers
- Outpatient physical therapy
- Mental health care
- Ambulance services
- One initial physical exam within the first 12 months of enrollment
Medicare Part C – Medicare Advantage
By choosing a Medicare Part C plan you will generally have access to services not available through Original Medicare (Parts A and B). Medicare Part C is offered by private insurers and you will likely pay a co-payment for covered services and see doctors in the plan’s network. While all Medicare Advantage plans follow rules set by Medicare, each plan can charge different out-of-pocket costs and have a different set of guidelines that must be followed in order to receive service. All services must be arranged through the Medicare Advantage plan that you join.
Depending on which plan you select, you are responsible for paying any applicable annual deductibles, co-payments or co-insurance on certain items or services. If you participate in a Medicare Advantage plan, you will pay both your monthly Part B premium and a monthly health plan premium. However, some Medicare Advantage plans have no monthly premiums. In most cases, you may join a Medicare Advantage plan if you are entitled to Part A and enrolled in Part B, if you live in the plan’s service area and if you do not have end-stage renal disease.
In addition to all services under Medicare Part A and Medicare Part B, many Medicare Advantage plans typically cover the following:
- Emergency and urgent care
- Vision services
- Hearing services
- Dental services
- Health and wellness programs
- Medicare Part D prescription drug coverage
Medicare Part D – Prescription Drugs
You are eligible for enrollment in a Medicare Part D prescription drug coverage plan if you have Medicare Part A and/or Medicare Part B. In order to receive Medicare Part D coverage you will enroll directly through your plan of choice (Medicare Part C), not through the Centers for Medicare and Medicaid Services or Social Security. Medicare Part D cost and coverage varies by plan, and typically involves a monthly premium, plus any potential co-payments or co-insurance for your prescriptions if you have met your annual deductible (if applicable).
If you are on a limited income, you may qualify for a Medicare program that gives you extra help with your prescription drug costs. This program, known as the LIS, or low-income subsidy, assists with Medicare Part D premiums, deductibles and co-pays.
In general, there are two types of plans that offer Medicare Part D prescription drug coverage.
- Medicare Advantage plans: HMO, PPO or other plans that provide Medicare Part D for the cost of their premiums
- Medicare prescription drug plans (PDP): Stand-alone plans that add drug coverage to Original Medicare (Parts A and B)
For More Information
You may visit the Medicare website or call 1-800-MEDICARE (1-800-633-4227) (toll free) or 1-877-486-2048 (toll-free TTY for the hearing/speech impaired), 24 hours a day, seven days a week or visit your local Social Security office, or call Social Security at 1-800-772-1213 (toll free) or 1-800-325-0778 (toll-free TTY for the hearing/speech impaired), Monday through Friday, 7 a.m. to 7 p.m.
As one of the very first employees of The Mesothelioma Center, Kaylen Jackson is dedicated to working with patients and families who have received a mesothelioma diagnosis. Throughout her experience, she recognized the need for a medical branch of our advocacy services. This led her to develop our Doctor Match program as well as our Medical Outreach efforts.