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Medicare Part A

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  1. Inpatient Hospital Care: This encompasses all care you receive after a physician admits you to a hospital. Medicare covers up to 90 days per benefit period in a general hospital, with an additional 60 lifetime reserve days. It also includes coverage for up to 190 lifetime days in a Medicare-certified psychiatric hospital.

  2. Skilled Nursing Facility Care: Medicare covers your room, board, and specific services offered in a skilled nursing facility, such as medications, tube feedings, and wound care. This coverage extends to up to 100 days per benefit period, contingent on the requirement of at least three consecutive days in the hospital within 30 days of skilled nursing facility admission and the necessity for skilled nursing or therapy services.

  3. Home Health Care: While typically covered by Part B, Part A comes into play if you have spent at least three consecutive days as a hospital inpatient within 14 days of receiving home care. It includes coverage for up to 100 days of daily care or an unlimited amount of intermittent care.

  4. Hospice Care: Medicare covers hospice care for as long as your healthcare provider certifies its necessity.

 

Medicare Part B

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  1. Provider Services: Part B covers medically necessary services.

  2. Durable Medical Equipment: It includes equipment with a medical purpose, designed for repeated use, and suitable for home use.

  3. Home Health Services: Part B provides coverage for skilled nursing or therapy care if you're homebound.

  4. Ambulance Services: Emergency ambulance transportation is covered. Limited non-emergency transportation is available when there's no safe alternative and it's medically necessary.

  5. Preventative Services: Outpatient physical, speech, and occupational therapy services administered by a Medicare-certified therapist are included.

  6. X-rays and Lab Tests: All doctor-ordered x-rays and lab tests are covered.

  7. Chiropractic Care: Coverage is provided when medically necessary to address subluxation of the spine.

  8. Certain Prescription Drugs: This category includes specific medications like immunosuppressants, select anti-cancer drugs, select antiemetic drugs, select dialysis medications, and other common drugs administered by a physician.

 

Medicare Part C

 

Medicare Part C, also referred to as Medicare Advantage, is a private health plan offered by insurance companies under contract with the federal government. While you remain enrolled in Original Medicare (Part A and Part B), Medicare Advantage plans can provide additional benefits not covered by Original Medicare, including:

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  1. Dental Coverage

  2. Vision Coverage

  3. Caregiver Counseling and Training

  4. Housekeeping Services

  5. Prescription Drug Coverage

 

Medicare Part D

 

Medicare Part D provides coverage for prescription drugs, including most outpatient prescription medications.

Part D is made available through private insurance companies, either as a standalone plan or as part of benefits included in a Medicare Advantage Plan.

Each Part D plan maintains a specific list of covered drugs known as a formulary. If the drug you require is not on the formulary, you have options to request an exception, pay out of pocket, or file an appeal.

It's important to note that these formularies can vary from one plan to another, so it's advisable to request a copy and review it. Nevertheless, all Part D plans are required to cover drugs falling into the following categories:

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  • HIV/AIDS treatment

  • Antidepressants

  • Antipsychotic medications

  • Anticonvulsive treatments for seizure disorders

  • Immunosuppressants

  • Anti-cancer drugs (except when they are covered under Part B)

 

Additionally, most vaccines are covered under Part D, unless they are already covered under Part B.

Medicare Part D comprises four phases of coverage:

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  1. Deductible Phase

  2. Initial Coverage Phase

  3. Coverage Gap or Donut Hole

  4. Catastrophic Phase

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