Medicare is confusing for many people because it is not only different from employer and individual health plans but is fraught with duplicate letters of the alphabet for both parts and plans under Medicare contributing to the confusion. The following defines these terms so you can discern what each letter represents.
The room and board portion coverage for hospital and rehabilitation benefits.
Medicare Part A includes the room and board of the hospital and skilled nursing coverage for Medicare. As long as you have worked for ten years, or forty quarters, the contributions to Medicare have already earned this benefit, so, there is no extra charge. If you were married ten years or more, and your spouse has worked ten years or more, you are still eligible under your spouse’s contribution at no extra charge. In addition, as long as it is precipitated by a three day admitted hospital stay, you are eligible for rehabilitative services, which is referred to as skilled nursing. Since that term is often confused with nursing home services, which are not covered by Medicare, we will associate rehab and skilled nursing interchangeably. Beware that hospital stays under observation status, do not qualify for the rehab benefit under original medicare. There is an advocacy group working to have the observation days under Medicare count for the skilled nursing benefit, but, they have been unsuccessful thus far.
When the client with Original Medicare enters the hospital, there is a deductible due. Once the deductible is paid, Medicare coverage begins and it covers a 60 day benefit period. If you reenter the hospital during that benefit period, the same deductible covers your stay. If you reenter the hospital after the 60 day benefit period expires, a new deductible will apply. The amount of the deductible is determined by Medicare and can change annually.
Also, under your Medicare Part A benefit, you are eligible for “room & board” at the rehab facility which is often housed in a skilled nursing facility. Not to be confused with nursing home or long term care which Medicare does not cover. As long as you are admitted to the hospital for three days, Medicare will pay your room and board for the first 20 days of rehab at no cost to you. Days 21-100 are available for a daily copay which cost does change annually, and any stay over 100 days must be paid by you, or your long term care insurance.
The medical portion of medicare including doctor visits, laboratory expenses, durable medical equipment, imaging diagnostics, intravenous drug treatments to name a few.
Medicare Part B covers two types of services for Medicare participants which include both preventative as well as those which are medically necessary to diagnose or treat medical conditions. Part B covers doctor visits whether you see them in an office, the hospital, or in rehab (skilled nursing.) Medicare Part B covers ambulance services, durable medical equipment (crutches, splints, walkers, hospital beds, scooters), as well as some injectable drug treatments. There is a monthly charge for Part B services as well as a penalty if you delay coverage.
Managed care plans whether HMO, PPO, PFFS, or D-SNP combine your medical, hospital and prescription coverage under an independent provider within specific network coverage.
Medicare Part C combines the services of both Part A, Part B, and sometimes Medicare Part D, into a managed health plan referred to as a Medicare Advantage Plan. While you need to be eligible for Medicare, the plans are supplied by independent insurance companies. The coverage has a designated network of doctors and facilities and some include prescription drugs as well as minimal dental and vision services. Participants must be well versed in the plan since there are costs associated not only with each service but pertaining to where the service is obtained. When enrolling in an Advantage plan, it should be viewed as a contract with changes expected annually. While enrollment can roll over each year, be forewarned and aware of changes to services and costs.
Prescription coverage under original Medicare.
Medicare Part D refers to prescription drug coverage for Medicare eligible enrollees. It is a stand alone prescription drug plan for persons who are enrolled in Medicare Part A. You may be enrolled in Medicare Part B to qualify, though it is not necessary and you cannot be enrolled in Medicare Part C since they have their own drug plan.
Medicare supplements or coverage gap plans which cover specific costs and deductibles under Parts A & B of original Medicare.
Letters depicting Prescription Drug Plan
Letters depicting Medicare Advantage & Prescription Drugs also referred to as Medicare Part C
Type of MAPD which limits membership to people with certain diseases or characteristics that tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve
Type of MAPD plan for eligible clients who have both Medicare and Medicaid, therefore they are Dual eligible.
