Medicare is the federal government’s health care program for individuals aged 65 and older. It also extends to younger people under 65 with certain disabilities, End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease. This crucial program helps millions of Americans access necessary health coverage. Understanding the different parts of Medicare and how they work is essential for navigating your healthcare options.
Medicare is structured into different parts, each covering specific aspects of healthcare services. Let’s break down the core components:
Exploring the Parts of Medicare: A, B, C, and D
Medicare is divided into four main parts, often referred to as Part A, Part B, Part C, and Part D. Each part offers distinct coverage, ensuring comprehensive healthcare access for beneficiaries.
Medicare Part A: Hospital Insurance
Part A, known as hospital insurance, primarily covers inpatient care. This includes services received during a hospital stay, in a skilled nursing facility, or at a hospice. It also covers some forms of home health care. If you require hospitalization or skilled nursing care, Part A is there to help cover those costs.
Medicare Part B: Medical Insurance
Part B, or medical insurance, covers a broader range of medical services. This includes doctor visits, outpatient care, preventive services, and home health care when not covered by Part A. Part B also extends to durable medical equipment (DME) and certain medications administered in a doctor’s office or outpatient setting. Think of Part B as covering your routine and specialist medical needs outside of hospital stays.
Medicare Part D: Prescription Drug Coverage
Part D is dedicated to prescription drug coverage. This benefit is offered through private insurance plans approved by Medicare. If you need assistance with the costs of your prescription medications, Part D plans can provide valuable support. Enrolling in a Part D plan means choosing a private plan that works with Medicare to manage your drug costs.
Medicare Advantage (Part C): Combining Parts A and B
Medicare Advantage, also known as Part C, offers an alternative way to receive your Medicare benefits. These plans are also provided by Medicare-approved private insurance companies. Medicare Advantage plans combine the coverage of Part A and Part B, and often include additional benefits such as vision, dental, and hearing care. Many Medicare Advantage plans also incorporate prescription drug coverage, effectively bundling Part C and Part D benefits.
Medicare and Federal Employee Health Benefits (FEHB)
For federal employees and retirees, understanding how Medicare interacts with the Federal Employee Health Benefits (FEHB) program is crucial. Your FEHB plan can work in conjunction with Medicare, potentially enhancing your overall coverage and reducing out-of-pocket expenses.
Your FEHB plan may offer benefits that coordinate with Medicare. When Medicare is considered the primary payer, meaning it pays for services first, your FEHB plan can then cover remaining costs. This coordination can help waive certain expenses like deductibles, coinsurance, and copayments, leading to significant savings.
FEHB offers specific options for annuitants enrolled in Medicare, including:
- Medicare drug benefits through FEHB: These provide standard Part D drug coverage. This can include features like a cap on insulin product costs and a yearly limit on out-of-pocket Part D drug expenses, providing cost predictability for essential medications.
- Medicare Advantage plans through FEHB: These plans, accessed via your FEHB program, cover everything Original Medicare (Parts A and B) covers, and often include extra benefits. These might include dental, vision, and hearing care, offering more comprehensive health coverage. These FEHB-linked Medicare Advantage plans also typically incorporate drug coverage comparable to Part D.
Enrollment Options: Navigating Medicare with FEHB
Enrolling in Medicare when you have FEHB involves understanding different pathways and considerations. It’s important to notify your FEHB plan when you enroll in Medicare to ensure proper benefit coordination and payment.
Enrollment At-a-Glance
The following tables summarize enrollment paths for different Medicare and FEHB plan types:
Plans offered through FEHB:
| If you want to enroll in… | Find a plan using the… | Enrollment happens by… |
| Medicare drug benefits accessed through your FEHB plan | – Your plan auto-enrolls you if it offers Medicare drug benefits – Your retirement system’s process |
