Do You Need all Four Parts of Medicare?
In the United States, Medicare has been the national health insurance program for millions of beneficiaries over the age of 65 or those under 65 with qualifying disabilities since 1965. In the beginning, Medicare had two parts. Part A covers health care services in hospitals, and Part B covers outpatient health care services like doctor’s visits.
In 1999, Medicare Advantage, also known as Medicare Part C, came into existence after the Balanced Budget Act was passed by the U.S. Congress in 1997. And finally, the fourth part of Medicare – Medicare Part D (prescription drug coverage) – became available for the first time in January of 2006 for beneficiaries who had Original Medicare Parts A and B and wanted to add prescription drug insurance.
If you’re closing in on 65, and getting prepared for Medicare enrollment, it’s a good idea to have the facts about the four different parts of Medicare, so you know which ones will meet your health insurance needs.
Do you need all four parts of Medicare?
The simple answer to the question in the heading is “no,” you don’t need to enroll in all four parts because Medicare doesn’t work that way. You can enroll in Original Medicare Part A if you aren’t automatically enrolled when you’re eligible. Many people sign up for Part B when they first qualify for Medicare, unless they have other creditable coverage.
Medicare recipients can choose to get their Parts A and B coverage through Original Medicare, which is the federal program, or they choose to get these benefits through Part C, commonly referred to as Medicare Advantage. Medicare Advantage (or Part C) plans include Parts A and B, but most include additional benefits.
Part D is prescription drug coverage is optional coverage, but most people enroll when first eligible for Medicare to avoid late enrollment penalties later.
The basics of the four parts of Medicare
Part A
Original Medicare Part A covers inpatient hospital care, skilled nursing facility care, certain types of care in nursing homes, hospice care, and home health care services.
Part B
Original Medicare Part B covers preventive care services and medically necessary services. Coverage also includes the following:
- Mental health care as an inpatient, outpatient, for partial hospitalization, and intensive outpatient programs
- Durable medical equipment like wheelchairs, nebulizers, etc.
- Certain outpatient prescription drugs that are administered by a health care provider
- Clinical research
- Ambulance transport
Part C
Medicare Advantage (Part C) plans are sold by private insurance companies that work with Medicare. Part C plans are an alternative way for you to get Medicare coverage. They must include all the same benefits as Original Medicare Parts A and B according to federal law.
Many Medicare Advantage plans may include extra benefits that Original Medicare doesn’t provide, such as routine dental care, hearing checkups and hearing aids, routine vision care and eyeglasses, memberships to fitness clubs, transportation services, and monthly allowance cards for over-the-counter benefits.
Part D
Medicare Part D (prescription drug) plans are sold by private insurance companies that work with Medicare. You can enroll in a stand-alone Prescription Drug Plan (PDP) if you have Original Medicare Part A, Part B, or both. Alternatively, if you choose to enroll in a Medicare Advantage (Part C) plan, most plans include prescription drug coverage and are sometimes referred to as MA-PDs.
PDPs and MA-PDs are offered by private companies so costs and benefits can vary. Each plan will have its own formulary, or list of covered drugs. Costs will be determined by what category or tier medications are in. Tier 1 generic drugs will be the least costly, while tier 5 specialty medications cost more.
If you’re closing in on 65, or you qualify for Medicare because of a disability, you should research your Medicare options and make an informed choice about which parts of Medicare can provide the right health care coverage for your needs and budget.