Medicare medical reimbursement classes are divided into four categories identified as Part A, B, C and D. Each part provides benefits for different types of medical services, supplies and equipment. The amount of coverage and reimbursement rules also differs for each part, but, generally speaking, in order to receive reimbursement for medical expenses, you must meet the basic requirement that the medical services, supplies or equipment you receive are medically necessary.
Part A: Hospital Insurance
Medicare Part A is a hospital insurance program that provides coverage for such medically necessary services as inpatient care at a hospital, skilled nursing facility care, hospice care and home health care for home-bound beneficiaries. Medical services received under Part A are often referred to as the Original Medicare Plan and, in addition to the requirement of medical necessity for reimbursement, any claim for reimbursement under Part A must be made within one full calendar year following the year in which the services were received. For example, a claim for medical services that were rendered on July 1, 2010, must be made by December 31, 2011. However, claims for reimbursement under Part A are typically submitted by the medical provider, not the beneficiary.
Part B: Medical Insurance
Medicare Part B is a supplemental medical insurance program with benefits paid for such medically necessary services as your primary doctor care and related medical services, outpatient hospital care, clinical diagnostic laboratory services and preventive services. Part B services also fall under the Original Medicare Plan and the rules regarding reimbursement are the same as the rules for Part A.
Part C: Medicare Advantage
Medicare Part C is referred to as Medicare Advantage and provides any beneficiary with the option of receiving the same benefits provided under the Original Medicare Plan from a managed care organization, such as a health maintenance organization (HMO), preferred provider organization (PPO) or other type of private health insurer. By using a managed care plan to receive your health care, there is unlikely to be any reimbursement issue like that found under Medicare Parts A and B. For all managed care plans, Medicare pays a fixed amount every month to the private insurance company managing the plan and, therefore, there is no need to file a claim with Medicare when services are rendered.
Part D: Prescription Drug Plans
Medicare Part D provides coverage for prescription drugs. You must enroll in a specific prescription drug plan to receive this coverage or belong to a managed care organization that provides this coverage. If your pharmacy does not participate in Medicare, you will not be reimbursed for your prescription drug expenses—you are on your own. Prescription drug plans are easy to locate using the official Medicare website, where you can even enroll in a plan, or by calling Medicare and requesting help with finding an appropriate plan.
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