When you choose Medicare benefits, it’s important to understand the different parts of the program. Medicare is broken down into four parts – A, B, C, and D, and you can choose how you get your health and prescription drug benefits. Original Medicare (Part A and Part B) is the default choice, with the option of adding Part D for prescription drug coverage at an additional cost. The other option is to go with Part C, the Medicare Advantage Plan, which allows you to receive benefits through an HMO or PPO. Part C can also include the Part D prescription drug benefit at an additional cost.
Here is a short overview of each Medicare part:
Medicare Part A (Hospital Insurance)
Medicare Part A helps cover inpatient care in hospitals, as well as skilled nursing facilities, hospice care and home health care. If you or your spouse paid Medicare taxes while working, you probably won’t need to pay a premium for Part A Medicare. Usually if you choose Part A, you must also have Part B.
Medicare Part B (Medical Insurance)
Medicare Part B covers medically necessary doctors’ services and outpatient care. It also covers some preventative services to keep you healthy. In 2009, the standard monthly premium for Part B is $96.40 each month. In addition, you are responsible for a yearly deductable of $135 before Medicare starts paying benefits. If you have limited income, the state may help you pay for your premium.
Medicare Part C (Medicare Advantage Plans – HMO or PPO)
Usually administered through an HMO or PPO, Medicare Part C is an alternate health coverage choice administered by private companies that have been approved by Medicare. It includes Part A and Part B, and can include includes prescription drug or other additional coverage. There is usually a monthly premium, and unlike Part A and Part B, you usually need a referral to see a doctor. Each Medicare Advantage Plan works differently, so make sure you pick the plan with the best coverage for you.
Medicare Part D (Medicare Prescription Drug Coverage)
Medicare Part D helps cover the cost of prescription drugs and is offered (usually at an additional cost) to everyone with Medicare. You get a membership card to show your pharmacist when you get your prescriptions filled. You may have to pay a copayment, coinsurance, or a deductible. Note that there is a late enrollment penalty if you sign up for Part D after your initial Medicare enrollment.
Appealing Denials of Coverage
If your Medicare claim has been denied, you can appeal in writing. Start your
Medicare Part A Appeal Denial Form or
Medicare Part B Appeal Denial Form now.