Medicare is a Great Program providing health benefits to older Americans.
It is also a very Big and Complex Program with many parts and subparts.
In general: Medicare is divided into 4 Main Divisions:
Part A - Hospital Coverage
Part B - Physician Coverage
Part C - Combines Part A, B and D (also called Medicare Advantage)
Part D - Pharmaceutical Coverage.
Medicare has a truly excellent web site explaining everything: Click Here.
You can directly enroll in Medicare: Click Here.
Prior to 2003, Medicare had only Part A and Part B. This “Original Medicare” provided excellent nation wide coverage for Hospital and Physician services. Parts A and B are still available and continue to provide excellent nation wide coverage. Parts A and B are managed by the Federal Government. As such, the management has no profit motive to deny or limit services. You enroll directly via Government Medicare and not via a sales agent. Medicare does not pay a commission for sales.
In 2003, Medicare was expanded to cover drugs (Part D) and added a managed care option, Part C (Medicare Advantage), which combines A, B and D. These plans are managed by Private Corporations who are paid by the Federal Government to cover health services. In most plans, you are confined to using local plan doctors, hospitals and other providers or you pay more or all of the costs. There is no guarantee of nation wide coverage. Such plans profit by denying or limiting services. You enroll via a sales agent or via the private corporation. Sales commissions are generally paid by such plans.
For the Medicare site explaining these differences: Click Here.
The Part C Plans may be a bit simpler to implement but come with limitations and denials. Many of my patients find out, too late, that the medications they have been taking for years are suddenly no longer approved. Referrals to tertiary medical centers may be denied. Diagnostic MRIs and CT scans are delayed or denied by private corporations who advertise their “Quality.” Remember, sales agents are paid by Part C plans and generally don’t even mention “Original Medicare” which pays no commission. If you choose a Part C plan, make sure you are not getting into a DISadvantage.
I generally recommend patients enroll in Part A and B (Original Medicare) and then buy a Part D plan to complete their coverage. This provides better and less hassle coverage throughout the country.
For Part D information: Click Here or check the Medicare Drug Plan Finder to find out
if your particular medications are covered.
Regardless of the Plan you choose, My office participates in ALL of them.
Good Luck !!!