Missouri Medicare Matters
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Medicare

What are the parts of Medicare?

Medicare

Health insurance for people 65 and older.  Under 65 with certain disabilities.

Medicare Part A

Hospitals

Inpatient hospital care – Semi-private room, meals, general nursing, other hospital services and supplies, as well as care in inpatient rehabilitation facilities and inpatient mental health care in a psychiatric hospital

Skilled Nursing Facility

Inpatient skilled nursing facility (SNF) care (not custodial or long-term care) if you meet certain criteria. Skilled care involves safe and effective care given by skilled nursing or rehabilitative staff. Skilled nursing and therapy staff includes registered nurses, licensed practical and vocational nurses, physical and occupational therapists, speech-language pathologists, and audiologists.

Home Health Care

Medicare covers medically necessary part-time or intermittent skilled nursing care and /or other therapy services. Home health services may include medical social services, durable medical equipment, and medical supplies for at home use. You must be homebound.

Hospice

You must be certified by your doctor and a hospice doctor that you have 6 months or less to live, therefore terminally ill. You must except comfort care (palliative care) instead of care to cure your illness.

Medicare Part B
Medical Insurance helps cover medically necessary:

  • Doctors’ services
  • Outpatient medical and surgical services and supplies
  • Clinical lab tests
  • Durable medical equipment (may need to use certain suppliers)
  • Diabetic testing supplies
  • Preventive services (like flu shots and a yearly wellness visit)
  • Home health care

Part C
Medicare Advantage

  • Medicare Advantage is sometimes called Part C—includes both Part A, Part B, and usually Part D
  • Private insurance companies approved by Medicare provide your Medicare coverage
  • In most MA Plans, you need to use plan doctors, hospitals, and other providers or you pay more or all of the costs (networks)

Part D
Prescription Drug Insurance

If you chose Original Medicare and you want prescription drug coverage, you must choose and join a Medicare Prescription Drug Plan. You usually pay a monthly premium.

These plans are run by private companies that contract with Medicare.

Medicare Part D is Medicare prescription drug coverage. Part D coverage is provided through Medicare Prescription Drug Plans (PDPs) and Medicare Advantage (MA) Plans with Medicare prescription drug coverage.

There are some other types of Medicare health plans that provide health care coverage which aren’t Medicare Advantage Plans, but are still part of Medicare, such as Medicare Cost Plans and Programs of All-inclusive Care for the Elderly (PACE). Some of these plans provide Medicare Part A and Part B coverage, while others provide Part B coverage only. Some also provide Part D. These plans have some of the same rules as MA Plans as you will see later in this presentation. However, each type of plan has special rules and exceptions, so you should contact any plans you’re interested in to get more details.