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An explanation of Medicare and its parts

Published November 16. 2013 09:28AM

Medicare is a federal health insurance program available to adults, beginning at age 65; as well as younger people who have disabilities or have end-stage renal disease.

It helps by covering services such as lab tests, surgeries and doctors visits; as well as medically necessary supplies like wheelchairs and walkers.

Susan Zeigler, care management supervisor for the Carbon County Area Agency on Aging, explained there are different types of Medicare available to meet peoples' personal needs including original Medicare (Parts A and B), advantage plans (Part C) and prescription drug coverage (Part D).

• Part A, which is usually premium free for seniors, covers inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care.

Zeigler stressed that even though seniors may not be ready for joining Medicare, they should still enroll for Part A to avoid a delay in enrollment penalty down the road.

• Part B covers two types of services including medically necessary services and supplies that meet the accepted standards of medical practice and preventive services such as flu and Hepatitis B shots, mammograms, bone mass measurements, Pap tests and pelvic exams, colorectal cancer screening, diabetes screening and self management training, and medical nutrition therapy.

It also covers clinical research, ambulance services, mental health services and limited outpatient prescription drugs.

Premiums for Part B, according to's 2013 costs statistics, will cost beneficiaries about $105 a month; with a $147 annual deductible before Medicare will begin paying.

• Part C or the Medicare Advantage Plan is a plan offered by private companies that contract with Medicare to provide both Parts A and B coverage.

They include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service plans, Special Needs plans and Medicare Medical Savings Account plans.

In addition, most advantage plans also offer some type of prescription drug coverage.

Advantage plans cover you in all emergency or urgently needed care; and must cover all services that are covered under Medicare Parts A and B; but your plan can choose not to cover some costs of services that aren't deemed medically necessary.

In some plans, other coverage such as vision, hearing and dental are included.

Premiums vary and your monthly costs are determined by coverage, annual deductible, copayments and coinsurance, the type of health care services you need, whether your doctor accepts your insurance, and if you have Medicaid.

• Part D or Medicare drug coverage, covers drugs used by individuals to treat various medical issues. There are different tiers of covered drugs and each tier is associated with a set cost.

Medicare beneficiaries must pay a premium, which varies by plan for Part D. This premium is in addition to the annual Part B premium.

In addition, many plans have up to a $325 deductible which must be met before the plan begins copayments or coinsurance for covered drugs.

Information compiled from, the official U.S. Government site for Medicare

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