Briefly describe Medicare Parts A, B, C, D.

Question

What will be an ideal response?

Answer 1

• Part A Hospital Insurance (HI): Part A provides a variety of hospital, physician, and other medical services for (1) persons 65 and over, (2) disabled individuals who are entitled to Social Security benefits, and (3) end-stage renal disease victims. Part A finances five basic benefits for the covered population: (1) 90 days of inpatient care in a benefit period, (2) a lifetime reserve of 60 days inpatient care, (3) 100 days of post-hospitalization care in a skilled nursing facility, (4) home health agency visits, and (5) three pints of blood, as part of an inpatient stay.
• Part B Supplementary Medical Insurance (SMI): Part B is designed to complement the HI program. It provides payments for physicians, physician-ordered supplies and services, outpatient hospital services, rural health clinic visits, and home health visits for individuals without Part A. In recent years, SMI has widened payment for preventive services, including bone mass measuring; cardiovascular screenings; colorectal cancer screenings; diabetes screenings; glaucoma tests; Pap tests; prostate cancer screenings; mammograms; and flu, pneumococcal, and hepatitis B shots. Physical exams are offered on a one-time basis within the first 6 months of enrollment. In addition, SMI includes hospice benefits.
• Part C Medicare Advantage Plans: Part C allows private HMOs to offer comprehensive services to Medicare enrollees in many parts of the country that already had established HMOs offering group coverage. Under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and beginning in 2006, PPOs and other managed care fee-for-service plans were added to Part C.
• Part D Medicare Prescription Drug Benefit: The most interesting feature of the prescription drug benefit is the so-called “doughnut hole” or gap. After paying a $250 deductible, Medicare pays 75 percent of the next $2,000 of prescription drug costs. When the patient has incurred $3,100 in drug costs, there is a gap in coverage, and the patient is responsible for financing the whole amount out of pocket. After the beneficiary has reached the $5,100 threshold, Part D pays about 95 percent of drug costs. For all patients that opt into this program, Medicare collects premiums on a monthly basis. Enrollees may choose from a wide variety of prescription drug plans, and the premiums vary significantly by plan and by region.