What you need to know about Medicare coverage plans

Medicare plans have made healthcare accessible and affordable for seniors and the disabled. There are four parts to the Medicare plans: Plan A, B, C, and D. Plans A and B are the original Medicare plans offered by the federal government. Plans C and D are Medicare Advantage plans offered by Medicare-approved private insurers and are optional. Here are more details of each Medicare plan.

Medicare Plan A

• Inpatient hospital care: After formal hospital admission, inpatient hospital care is given. Plan A offers coverage for at least 90 days of stay in a general hospital. This plan is applicable for each benefit period that has to be renewed regularly with an insurance renewal. Besides, 60 lifetime reserve days are also covered. For those requiring care for mental health, Plan A covers 190 lifetime days in a Medicare-certified hospital.
• SNF care: Skilled nursing facility care or SNF care are for those who require assistance daily. Medicare Plan A covers multiple SNF services, including wound care, tube feedings, and medicine administration. Besides, the room and board are also covered. To qualify for these services, one must be registered as an inpatient for a minimum of 3 successive days within 30 days of SNF admission.
• Home health care: For patients requiring skilled care at home, Medicare offers coverage for daily as well as intermittent care. To qualify, one needs to spend at least three successive days as an inpatient within two weeks of registering for home health care. In addition, terminally ill patients can opt for hospice care. Medicare Plan A will cover hospice care for as long as a provider determines that the patient requires it.

Medicare Plan B

• DME: Medicare Plan B covers the cost of durable medical equipment or DME. These are medical equipment used at homes, such as oxygen tanks, wheelchairs, walkers, and certain other medical assistive equipment. DME can be purchased or rented from a supplier approved by Medicare. A provider certificate stating the requirement of the equipment by the patient will be required for renting or purchasing.
• Ambulance services: Plan B also offers coverage for transportation in case of a medical emergency. The plan covers the transportation cost to hospitals. Coverage is also offered for non-emergency situations that require an ambulette or ambulance. This is especially applicable in cases where there is no safe alternative transportation, and it is medically essential to transport a patient. However, the Medicare coverage for such situations comes with a few terms and conditions.
• Miscellaneous services: These include provider services for medically essential services received from licensed health practitioners. Those who are not eligible for home health services through Plan A can avail them through Plan B. X-rays, lab tests, and chiropractic care (for medically necessary manipulation of the spine) are also covered. Additionally, preventive services such as screening and counselling as well as outpatient occupational, speech, and physical therapy services are included too.

Medicare Advantage Plan C
Medicare Plan C is inclusive of Plans A and B. It covers everything under the original Medicare plans, along with extra services such as vision and dental care. It also covers the cost of wheel ramps, meal delivery, and shower grips. This plan is usually available as preferred provider organizations (PPOs) or health maintenance organizations (HMOs). The basic difference between both is that HMO requires a referral from a primary care doctor to see specialists. At the same time, PPOs have networks of doctors and facilities that do not require any referral.

Medicare Advantage Plan D
This plan offers coverage for prescription medications. Plan D can be availed through private insurers approved by Medicare. These plans require the payment of premiums as well as out-of-pocket costs, which can be in the form of co-pays, annual deductibles, or a percent of the total medical cost. The list of medications eligible under Plan D coverage changes every year. Read the documentation carefully before enrolling.