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Medicare Information

MEDICARE PARTS A, B AND D

Part A
In general, Part A covers:

  • Hospital care
  • Skilled nursing facility care
  • Nursing home care (as long as custodial care isn't the only care you need)
  • Hospice
  • Home health services

Part B
Part B covers 2 types of services:

  • Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice. Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
  • You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.

Part B covers things like:

  • Clinical research 
  • Ambulance services
  • Durable medical equipment (DME)
  • Mental health
  • Inpatient
  • Outpatient
  • Partial hospitalization
  • Getting a second opinion before surgery
  • Limited outpatient prescription drugs

Part D

  • Each Medicare drug plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have a different cost.
  • A drug in a lower tier will generally cost you less than a drug in a higher tier. Your prescriber may think you need a drug that's on a higher tier. If so, you or your prescriber can sometimes ask your plan for an exception to get a lower copayment.
  • A Medicare drug plan can make some changes to its formulary during the year within guidelines set by Medicare. If the change involves a drug you’re currently taking, your plan must do one of these:
  • Provide written notice to you at least 60 days prior to the date the change becomes effective.
  • At the time you request a refill, provide both of these:
  • A written notice of the change
  • A 60-day supply of the drug under the same plan rules as before the change

The Center for Medicare & Medicaid Services (CMS) publishes a Medicare & You Guide each year. This is a great resource to learn about Medciare and can assist you in your enrollment. You can access this guide by clicking the image below.