The benefits of Medicare are available in a variety of situations, primarily to those who are 65 or older. If you are under 65, you're also entitled to Medicare benefits if you meet special criteria, such as having amyotrophic lateral sclerosis--Lou Gehrig's disease--or permanent kidney failure and require dialysis. Medicare benefits are divided into four parts: Part A - hospital insurance benefits; Part B - medical insurance benefits not covered by Part A; Part C - provides beneficiaries with the option of receiving benefits through a private insurer; and Part D - prescription drug benefits. Receiving Medicare benefits is subject to the requirement of medical necessity.
Part A: Hospital Insurance
Medicare Part A provides benefits for any hospitalization requiring at least a one-night stay. The benefits include coverage for tests and doctor's fees, as well as a semiprivate room and food. If your hospitalization was for at least three days, Part A benefits will also include coverage for up to 100 days of convalescing in a skilled nursing facility. The first 20 days are paid in full with the remaining 80 days requiring a co-payment as determined by the Social Security Administration (SSA), which for 2010 is $137.50 per day.
Part B: Medical Insurance
Part B benefits cover medically necessary services you receive that are not covered under Part A, typically as an outpatient. For example, this coverage includes x-rays, laboratory and diagnostic tests, as well as outpatient hospital procedures such as blood transfusions and renal dialysis. If you receive influenza or pneumonia vaccinations, or are given other medication during an office visit, this is covered as well. Medications received from a pharmacy are not covered under Part B. You will pay a monthly premium for Part B coverage, which will vary depending upon your income for the two years prior to enrolling in Medicare.
Part C: Medicare Advantage Plans
Part C is called the Medicare Advantage Plans, also known as MA Plans, which provide you with the option of receiving your Medicare Part A and B benefits through a private insurer. These plans can offer more coverage, but must provide at least the same coverage provided by Medicare and follow rules set by Medicare. There are several different types of Medicare Advantage Plans and they do not all work the same way. Before joining such a plan, it is important to know the plan's rules and costs and whether it can meet your needs. For most plans, you will pay a monthly premium as well as your Part B premium.
Part D: Prescription Drug Plans
Medicare's coverage for prescription drugs---Part D---went into effect on January 1, 2006, with the enactment of the Medicare Prescription Drug, Improvement, and Modernization Act. You must be enrolled in Medicare to receive this benefit which will be administered through a Prescription Drug Plan (PDP) of your choice. If you joined a Medicare Advantage Plan, you will receive Part D benefits if the plan offers this coverage, usually referred to as an MA-PD plan. Your particular Part D benefits will depend on the PDP you choose. Although the PDPs must be approved by Medicare and subject to its regulations, the PDPs are administered by private insurers and vary in the type or class of drugs that are covered.
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