• Medicare Part A
• Medicare Part B
• Medicare Part C
• Medicare Part D

Medicare Part A
Medicare Part A is the portion of Medicare that is available premium free to all eligible individuals. Medicare Part A provides services associated with hospital, hospice, skilled nursing care, and home health care.

Specific services covered under Part A include:

• A semiprivate room
• Meals
• Nursing services, including nursing in special care units such as intensive care
• Medications administered while in the hospital
• Clinical laboratory tests
• X-ray and radiotherapy
• Medical supplies, such as dressings and intravenous lines
• The use of equipment such as wheelchairs
• Operating room and recovery room charges
• Rehabilitation services, such as physical therapy and speech pathology, provided in the hospital
• Medicare will not pay for items considered luxuries, such as a television in your room or for a private room, unless your condition renders it medically necessary.

For inpatient hospital stays, Medicare will pay:

• 100 percent of costs for up to 60 days of inpatient care, after you pay the deductible.
• After 60 days, beneficiaries are responsible for coinsurance costs. In 2006, beneficiaries must pay $238/day (up from $228/day in 2005).
• Beneficiaries are also entitled to a lifetime reserve of 60 additional days. If those reserve days are also used, beneficiaries must pay $476/day in 2006 (up from $456/day in 2005) for days 91 to 150.
  
  Tip: Part A coverage pays for all Medicare-approved inpatient hospital costs except for your physician bills, which are covered under Part B. Medicare approves costs considered reasonable and medically necessary.

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Medicare Part B

Medicare Part B is the medical insurance portion of Medicare, which covers physician services, outpatient hospital care, and many other services typically covered under health insurance plans. Part B is financed through monthly premiums paid by you, the enrollee, and by contributions from the federal government.

Premiums
In 2005, the premium for Medicare Part B is $78.20. The premium is indexed for inflation, and typically increases each year. Beginning in 2007, under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (2003 Medicare Act), beneficiaries with higher incomes ($80,000 and over for individuals, $160,000 and over for married couples) will pay a higher premium based on a sliding scale that will be phased in over five years.

Deductibles
The Medicare Part B deductible is $110 in 2005 (up from $100 in previous years). Beginning in 2006, it will be increased by the same percentage as the premium.

Medical care that is not inpatient is usually covered under Medicare Part B. Medicare Part B covers 80 percent of medically necessary physician or outpatient charges, including charges from a physician for care received in a hospital.

Currently, services covered under Medicare Part B include:

• Physician and surgeon fees
• Outpatient services
• Immunosuppressive drugs
• Blood service, after you pay for the first three pints of blood in any calendar year
• Clinical laboratory services
• Some coverage for outpatient mental health visits
• Ambulance service
  
  Caution: Medicare regulations specifying what it will cover almost always begin with a general rule, followed by exceptions. If you are denied coverage, it is always wise to look into whether or not you can meet one of the exceptions.

Services excluded from Medicare Part B coverage

In general, Medicare pays only for services it considers reasonable or Medically necessary. Specific exclusions include:

• Cosmetic surgery, unless particular medical conditions render it necessary
• Procedures considered experimental--for example, heart transplants were not covered by Medicare until 1986
• Hearing aids and fittings
• Chiropractic services, except for treatment of subluxation (partial dislocation) of the spine
• Most eyeglasses and eye exams
• Most dentures and dental care
• Prescription drugs you administer yourself, such as those you buy at a drug store and take
• at home (exceptions are immunosuppressive drugs and antirejection drugs for kidney transplant patients)
• Over-the-counter drugs
• Care outside of the United States (except when a Mexican or Canadian hospital is closer, such as in an emergency, even though you reside in the United States, or if you require care while traveling through Canada en route to Alaska)
  
  Tip: Under the 2003 Medicare Act, prescription drug coverage will begin in 2006, under Medicare Part D (prescription drug benefit). Until then, Medicare beneficiaries are able to purchase Medicare-approved discount cards from private companies that will help them save money on most prescription drug purchases. For more information on this benefit and other changes to Medicare, see The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 or visit www.medicare.gov .

For the most part, Medicare does not pay for preventive services, such as routine physical exams. Preventive services Medicare does cover, however, include:

• Annual mammograms for individuals age 40 or older, exclusive of any Medicare deductible
• Pap smears
• Pneumococcal vaccines
• Hepatitis B vaccines for high-risk individuals
• Pelvic and breast cancer screenings every three years for women, or annually for high-risk women or women with a relevant medical history, exclusive of any Medicare deductible
• Prostrate and colorectal cancer screening
• Bone density measurements for women at risk for osteoporosis
• Self-management training for individuals with diabetes

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Medicare Part C

 Medicare Part C, which is also called medicare Advantage plan, is an alternative to the Parts A and B combination, Original Medicare.

Why choose a Medicare Advantage plan?
When you enroll in any Medicare Advantage plan, you will still get all Original Medicare covered services, but you may also obtain extra benefits and services not offered by Original Medicare, and/or you may be able to reduce your out-of-pocket costs. The extra benefits and services you receive and/or the amount of money you save will depend on which Medicare Advantage plan you choose.

What is not covered by Medicare Parts A and B?
The following medical expenses in not included by Original Medicare, Medicare Part A and B.

• Your Out-of-Pocket Responsibilities: Part B premium, Deductibles, Coinsurance, or co-payments that apply
• Most prescription drugs
• Dental care
• Hearing aids
• Vision care
• Custodial care at home or in a nursing home

Medicare Part C may cover some of these expenses, or you can purchase a supplemental Medigap insurance policy that will help cover what Medicare does not.

Enrolling in a Medicare Advantage plan
In order to enroll in a Medicare Advantage plan, you must be entitled to Part A and enrolled in Part B. You can enroll only in plans that are available in your area. You can generally join (or leave) a Medicare Advantage plan at any time. However, all plans must accept new members from November 15 through December 31 of each year, unless the plan has reached its enrollment limit.

Tip: You generally can't join a Medicare Advantage plan if you have end-stage renal disease.

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Medicare Part D

Medicare Part D is a plan specifically for prescription drugs coverage. You can either enroll as a stand alone Prescription Drug Plan (PDP) with Original Medicare or as an addition to Part C. In Medicare Part D, you, the enrollee, is responsible for the copayments and deductibles.

Click here for Medicare Prescription Drug Plan Finder

Note: There are some out-of-pocket cost changes in Medicare Part D in 2007. Please refer to your Medicare booklet for specific changes.

Enrollment
Medicare Part D is not an automatic enrollment. You have to select it separately. Part D can be also available from insurance companies that have a contract with Medicare.

If you need help choosing Medicare prescription drug coverage that meets
your needs, you can get personalized information by:

• visiting www.medicare.gov on the web.
• calling 1-800-MEDICARE (1-800-633-4227). TTY users should call
  1-877-486-2048. Have your Medicare card, a list of the drugs you use, and the name of the pharmacy you use ready when you call.
• getting a free copy of the booklet “Your Guide to Medicare Prescription Drug Coverage,” (CMS Pub. No. 11109), on www.medicare.gov, or by calling 1-800-MEDICARE.
• calling your State Health Insurance Assistance Program
• checking for local events for help enrolling. Contact your local office on aging. For the telephone number, visit www.eldercare.gov on the web.

What is a coverage gap in Medicare Part D?

The coverage gap (also called the "donut hole") is the point in the government's basic prescription drug plan where the plan "takes a break" in coverage. This is where, you, the enrollee, pay the full cost for your prescription drugs. The coverage gap applies only after you've paid a certain amount of out of your pocket for prescription drugs.

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