This blog will discuss four components of the Medicare program: Part A, B, C, and D. We will also discuss different aspects of America’s national health insurance system.
Part A is a section of Original Medicare. It covers hospital stays. Part A provides coverage for semi-private rooms and food and medical tests. Part A is Medicare’s primary benefit, the only part of Medicare that most Americans aged 65 and over are eligible to receive without a premium.
The maximum hospitalization duration covered under Part A is 90 days. Part A covers the initial 60 days. Excluding a one-time deductible at the beginning of the 60 days and a daily copayment after that. Medicare penalizes hospitals when they have readmissions, which is not uncommon. Penalized readmissions aim to promote better post-hospital treatment and increase referrals to hospices. Part A covers a short stay to recuperate or heal in the skilled nursing center and if it is less than 100 days. Medicare Part A covers hospice benefits for terminally ill people who have less than six months to live.
Part B is also part of the Original Medicare program, enacted in 1966. It helps people pay for things that Part A doesn’t cover. Compared to Part A; Part B can be an option. It is generally deferred when the person who is the beneficiary or their spouse is employed and has the health insurance coverage of their group employers. There is a penalty for the life of 10 percent each year for not being enrolled for Part B when first eligible.
The coverage under Part B starts once the patient has met the usually small deductible ($198 for 2020). Medicare pays 80% afterward for any approved products and services. Beneficiaries can avail of Medicare supplements (sometimes called “Medigap”) to pay another 20% of their costs or pay out of pocket. The monthly fee of Part B is $144.60 (or greater depending on the beneficiary’s income) when writing the article. Part B coverage has outpatient physician services, visit nurse services, X-rays, diagnostic and lab tests, blood transfusions, renal dialysis vaccinations, chemotherapy procedures for outpatients, and several other treatments for outpatients. Furthermore, part B also covers the cost of durable medical equipment (DME) like walkers, canes, wheelchairs, lifts, mobility scooters, and lifts chairs.
Part C also known as Medicare Advantage, is the private sector of Medicare. With the Medicare Advantage policy, seniors can benefit from Part A, B, and D and extra benefits not covered by the government program. For example, dental and vision treatment, annual physicals, and premium services such as Health club memberships. The cost of Medicare Advantage is different based on the plan. Most Medicare Advantage Part C plans are healthcare maintenance organizations (HMOs); however, some are preferred providers. Even though people with Medicare Advantage plans can have more benefits than those with Original Medicare, they often have less extensive providers’ networks.
Participation in Medicare Advantage increased from 1 percent of total Medicare enrollees in 1997. It was approximately 37% in 2019. Americans are enrolling in Advantage plans, which creates a lucrative industry. This is the ideal time to enter the upcoming industry.
Part D assists older people in receiving prescription coverage for their medications. Anyone with Part B or A can be eligible to apply for Part D. It covers self-administered drugs. Contrary to Original Medicare, Part D isn’t standardized. Still, Centers for Medicare and Medicaid Services run it. Plans differ concerning the drugs they cover, but most programs provide the entire (or “substantially all” medications in the categories of protection: antipsychotic, anticancer such as anticonvulsant, antidepressant immune-suppressant, and HIV as well as AIDS drugs.
About 25 states offer extra prescription drug coverage besides Part D. The Federal Social Security Administration offers an Extra Help program to seniors with low incomes to ensure they pay no cost for drugs. It is worth noting that the Part D monthly premium varies according to plan, with higher-income consumers often paying higher.