Comprehensive Guide to Medicare Plan Options

Medicare is a government-funded health insurance program designed for individuals aged 65 and older, people receiving Social Security Disability benefits, or those under 65 with End-Stage Renal Disease. Managed by the Centers for Medicare & Medicaid Services, it offers different coverage options.

Medicare is divided into four parts, each serving distinct healthcare needs. Here’s a brief overview:

Plan A
Known as Original Medicare, Parts A and B are federally administered. Part A covers inpatient hospital stays, skilled nursing facilities (not long-term care), home health services, and hospice care.

Part B
Provides outpatient and medical services, including:

• Necessary medical services
  Treatments and supplies essential for diagnosis or care, conforming to medical standards.
• Preventive care
  Services aimed at early detection and prevention of illnesses, such as flu shots.

Part B also covers clinical research, durable medical equipment, ambulance services, outpatient and partial hospitalization for mental health, second opinions before surgeries, and limited outpatient medications.

Part C
While Original Medicare covers most costs, beneficiaries can opt for Medicare Advantage (Part C), offered by private insurers approved by Medicare. These plans include all Part A and B benefits plus extras like dental, vision, hearing, and wellness programs. Medicare pays a fixed monthly fee to these providers, who must follow Medicare guidelines.

Part D
Covers prescription drugs. Offered by private companies either as standalone plans for Original Medicare enrollees or included within Medicare Advantage plans. Each plan has a formulary listing covered medications; drugs not included may require out-of-pocket payments, exceptions, or appeals. Certain medications, such as over-the-counter drugs or weight management medicines, are excluded by law.