Medicare Part A, B, C, D

Understanding the various types of Medicare coverage and helping your patients understand their coverage is essential to running an efficient practice.

Most patients choose traditional Medicare, sometimes known as “original Medicare.” This benefit is offered by the Centers for Medicare and Medicaid Services (CMS.) This plan covers hospitalizations through the Part A benefit.

The Part B benefit covers basic medical care, such as physician visits and most DMEPOS items. The patient pays a small premium for Part B and then has a co-pay for most services. The co-pay is typically 20% of the allowed amount. Any provider participating in the Medicare plan may provide services to the patient.

An option for patients is Part C, Medicare Advantage (MA) plans. These plans are offered and managed by private health plans. MA plans must cover all the services included in traditional Part A and Part B, but they may put restrictions on who provides the service and amounts paid. MA plans may provide additional wellness benefits like routine eye exams or gym discounts. Typically, the patient will have little or no co-pays under MA plans.

Part D is prescription drug coverage.

For more information about what is covered by Medicare and Medicare Advantage plans go here.