An Affiliate of Bridlewood Insurance

The ABCD’s of Medicare

Part A – Hospital Services

Medicare Part A beneficiaries receive coverage for hospital expenses that are critical for inpatient care. These include a semi-private room, nursing services, meals, medications required during inpatient treatment, and other related services and supplies from the hospital.

Medicare Part A insurance DOES NOT cover a private hospital room, private-duty nursing, or personal care items such as shampoo, telephone, and television. It also does not cover the cost of blood unless the hospital receives blood from a blood bank without a charge. For hospitals purchasing the blood, the cost of the first three units is the beneficiary’s responsibility.

Coverage Includes:

Costs Associated with Part A:

Part B – Outpatient / Physician Services

Medicare Part B beneficiaries receive coverage for medical expenses that are important for outpatient health care. Anyone eligible for Medicare Part A is qualified for Medicare Part B by enrolling and paying a standard monthly premium (premium tiers based on Modified Adjusted Gross Income two years prior to enroling).

Coverage Includes:

Costs Associated with Part B:

A Partial List of Services NOT Covered by Medicare Part B:

Part C – Medicare Advantage Plans

One of the options a Medicare beneficiary has as a resource to tackle Original Medicare’s Co-Insurance, Co-Pays, and Deductibles is using a Medicare Advantage plan, also known as Part C.

Medicare Advantage plans are Medicare approved insurance plans offered through private health insurance companies. They combine Original Medicare, Part A, Part B, and generally Part D into one plan. Enrolling in a Medicare Advantage plan requires a person to first enroll in Original Medicare Part A & Part B and to reside in the plan’s service area.

Medicare Advantage plans, at a minimum, include all benefits, services, and coverages outlined in Original Medicare. They generally have additional benefits and services Medicare does not cover, such as:

If a person enrolls in a Medicare Advantage plan, they must continue to pay their Original Medicare Part B premium to the Social Security Office. With that said, Medicare Advantage plan premiums (paid to the insurance company) vary, but there are many $0 premium plans to choose from. This is a great option for reducing the exposure to Medicare’s 20% co-insurance. By selecting a Medicare Advantage plan, the insurance company becomes your primary insurance, and by doing so, it has very distinct advantages and disadvantages, such as:



Two Types of Medicare Advantage Plans: HMO or PPO

HMO – Health Maintenance Organization:

PPO – Preferred Provider Organization:

Part D – Prescription Drug Plans

Part D Prescription Drug plans are Medicare-approved plans offered through private health insurance companies. These plans are either found as a Stand-Alone Prescription Drug Plan or included in a Medicare Advantage Plan (Part C). Part D Prescription Drug plans cover brand name and generic medications supplied by a pharmacy. Coverage varies by plan, and each plan has a formulary. A formulary is a list of the drugs covered by that plan.

The Costs Associated with Part D:

Understanding Medicare Part D Coverage Stages:

*Total Drug Costs:  Equals the amount a beneficiary pays (deductible and co-pay) and what the plan pays for prescription drugs each calendar year. It does not include the plan premiums.

*Total Out-of-Pocket Costs:  Equals the amount the beneficiary pays, including the deductible for prescription drugs each calendar year. The total out-of-pocket costs also include the discount paid by the drug manufacturers during this stage. It does not include the plan premiums.

Note – The Part D deductible and coverage gap do not apply when a person qualifies for Extra Help.

Medicare Supplement Plans

A Medicare Supplement plan helps “fill the gap” by partially or fully covering expenses that original Medicare Part A and Part B don’t cover.

For instance, Medicare Part B generally covers 80% of Part B expenses. You’re responsible for the remaining 20%. A Medicare Supplement insurance plan will partially pay your share.

Medicare Supplement plan benefits are “standardized.” This simply means that no matter what insurance company you chose to enroll through, the Part A and Part B benefits are the same with each company. The difference between companies is their premium rates, financial stability, and their customer service.