Clear Up Your Confusion about Medicare Benefits: The Complete Guide, Part 1

Are you one of the nearly 60 million Americans currently enrolled in Medicare? Despite Medicare’s broad use, many people are unsure of what all Medicare covers and how to use that coverage. Even after enrollment, Medicare’s rules, deadlines and costs can be overwhelming. Parts A through D, hospital stays and home health care, supplements and prescribed medication—so much is involved!

For example, you might know that you can use Medicare if you’re admitted to the hospital or need to see a doctor, but you may be unsure how Medicare works when you need ancillary services such as physical therapy. To help our Heather Lane Physical Therapy community understand what to expect if you’re enrolled in Medicare and need physical therapy, we’ve put together a 3-part series. This is Part 1, an overview.

Medicare’s 4 parts

Medicare Part A is hospital insurance. Part A pays for stays in the hospital as well as long-term care, including:

  • Skilled nursing facility stays
  • Hospice care
  • Home health care

Part A also pays for any services you receive while staying in a hospital or facility. So if your hospital stay includes any treatments or therapies, including physical therapy, it will be covered under Part A.

Medicare Part B is medical insurance. Part B pays for visits to doctor’s offices, trips to the ER, medical equipment you might need at home, and services like physical therapy. Generally, all outpatient services you receive are covered under Part B.

Together, Part A and Part B make up what is called “original Medicare.”  You might be more familiar with original Medicare than with other parts or supplements. Many people use only original Medicare and never purchase any other parts or supplements.

Medicare Part C, also called “Medicare Advantage,” sometimes also is grouped under the “original Medicare” label. Part C refers to plans with private insurance companies that contract with Medicare. These privately provided plans are required to offer, at minimum, the same coverage as original Medicare. Many of these plans go beyond that to offer additional services or coverage.

Medical Part D pays for prescription drugs. There is no coverage for prescriptions under original Medicare, so buying a Part D plan from Medicare to add to your original Medicare can help cover those costs. However, if you opt to have a Part C plan, that plan may include prescription coverage. In that case, you would not purchase Part D from Medicare.

What is Medigap?

There are 10 types of Medigap plans, also known as Medicare supplement plans. Medigap is designed to help you pay for some costs that would normally come out of your pocket when you use original Medicare, including:

  • Deductibles
  • Coinsurances
  • Copayments

Medigap plans also can help you pay for extras such as health care while you’re traveling outside of the United States. Like Medicare Part C, plans are offered by private companies and regulated by Medicare.

Applying Medicare to physical therapy

How you use Medicare to get physical therapy will depend on where you get your physical therapy and what parts of Medicare you’re enrolled in. Coming up in our Medicare series, Part 2 and Part 3 will look at each part closer and explain how it can help you get the physical therapy you need. 

(Image from the cover of the official handbook)

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