Medicare Part A, B, C And D: Understanding The Claims Requirement, Age Limit And Benefits!


Medicare A generally covers inpatient hospital expenses. It may cover some outpatient expenses or as well as physical therapy for somebody who is in a nursing home. However, that's not covered under the inpatient part. It is separately payable under outpatient services.

Medicare Part B generally covers outpatient health care expenses including physician's fees. It would be outpatient hospital services, an ambulatory surgery centre, clinics, physician's services, physical therapy and some other services, radiologist, laboratory generally.

There is a Medicare Part B of A. And that's where maybe a physical therapy would be paid out of part B for somebody who is hospitalized or an inpatient in a nursing home. Basically, what this refers to is there are two separate parts of money. There is the Medicare A part of money and the Medicare B part of money. And how you submit those claims indicates where that money is coming from to cover that service.

Medicare C, Medicare Advantage, formerly known as Medicare Plus Choice, this is your HMO, your managed care of Medicare. For Medicare Part A, most of us who have lived in the United States and worked and paid into a Medicare Part A, do not have to pay a premium for Medicare Part A. Although, it is available for those who have never worked in the United States and paid in to the system.

At age 65, you become eligible for Medicare Part A coverage. Part B requires a premium. Currently, it's very close to $100 and there are limitations on what these services cover.

Medicare Part C is a managed care organization, even if you've had Medicare Part A and Part B. If you decide you're going to take Medicare Part C which is a choice, it's like a manage care. You pay a monthly premium that covers all your services depending on the plan and you will no longer have Medicare Part A and Part B. It replaces A and B. Medicare Part D is the Prescription Drug Program.
In the past under Medicare Part A and B, prescription drugs were not covered. If you went to your doctor, if they used an antiseptic and aesthetic or something in the physician's office, which was probably covered by Medicare. But if they give you a prescription, you went to the pharmacy and took it home, you had to pay that out of pocket.

Medicare Part D is a program that came in. Try to remember the years for your own benefit. Obviously, there was a lot of confusion at first because there were so many options. But this covers prescription drugs for Medicare eligible beneficiaries.
That's another thing that people learn as they work with insurance. Some places, they're called subscribers. Some places, they're members, and under Medicare and Tricare, your beneficiaries. For Medicaid, sometimes they call up clients, sometimes members. So there's different terminology that's used.

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