A Guide to Medicare Coverage

Signed into law by then-President Lyndon Johnson on July 30th, 1965, Medicare coverage began as a social insurance program for American citizens age 65 or older. Today Medicare also covers citizens who may not be 65 years old, but demonstrate need. Those suffering with Lou Gehrig’s Disease, in need of a kidney transplant or have been receiving Social Security benefits for at least 24 months are all examples of people who qualify for Medicare.

Originally, Medicare coverage applied only to Hospital Insurance (known as Part A) and Medical Insurance (Part B). Former President Harry S. Truman was the first recipient of an official Medicare card, which then rarely entitled the holder to prescription drug coverage. Presently, comprehensive drug coverage is provided by many private insurance plans.

Medicare Part A

Part A of Medicare is Hospital Insurance, which will cover hospital stays, nursing home or assisted-living home care for a period of time. Medicare Part A, covers inpatient hospital care when all of these are true:

  1. You’re admitted to the hospital as an inpatient after an official doctor’s order, which says you need inpatient hospital care to treat your illness or injury.
  2. The hospital accepts Medicare.
  3. In certain cases, the Utilization Review Committee of the hospital approves your stay while you’re in the hospital.

Regarding nursing-home stays, Medicare will only cover 100 days per ailment. The first 20 days are paid for by Medicare in full; the next 80 days require a copayment of $170.50 per day (as of 2019). Whenever you go 60 days without using Medicare to help pay for a nursing home stay, the 100-day clock is reset and you qualify for a new 100 day period.

Medicare Part B

Part B of Medicare deals with Medical Insurance. This section covers most outpatient services and medically necessary products that Part A leaves untouched. Everything from doctors visits to immunosuppressive drugs for organ-transplant recipients are covered by Part B, including limited ambulance transportation.

In addition to outpatient doctors services and treatments like chemotherapy, Part B helps you to pay for durable medical equipment (DME). Examples of DME include mobility scooters, prosthetic limbs, canes and oxygen.

Medicare Part C

Part C of Medicare deals with Medicare Advantage plans. After the Balanced Budget Act of 1997 passed, Medicare recipients were given the choice to either keep their original Medicare plan (Parts A and B) or receive their benefits through a private health insurance plan. After the Medicare Prescription Drug, Improvement and Modernization Act was enacted in 2003, those using private health insurance through Part C became known as Medicare Advantage (MA) recipients.

If you choose Medicare Advantage, Medicare will pay a set amount each month toward private health insurance. You’re required to pay any additional premiums, and in many cases you’ll have to pay a fixed co-payment amount each time you see a doctor. By law, the private insurance company you choose must offer a benefit package that is at least as good as the one provided by Medicare Parts A and B.

Medicare Part D

Medicare Part D provides coverage for prescription drug plans and went into effect at the beginning of 2006. If you use Medicare Part A or B, you are eligible for Part D. If you’re using an MA Plan, you can adjust your benefits to take advantage of Part D, in which case the overall plan becomes an MAPD.


To get Medicare Part D, you need to enroll in a Prescription Drug Plan (PDP) or change your MA coverage to MAPD. Costs and benefits vary between the different plans, and medications that you need may not be covered by all plans. Some drugs, such as cough suppressants, benzodiazepines and barbiturates, aren’t covered at all.

To get the best Medicare Part D coverage at the best price, you should compile a list of your prescriptions and talk to your pharmacist, MA provider or a Licensed Medicare Agent. You can get a head start by visiting https://medicare.gov, which provides a list of Medicare Part D options by state when you provide your prescriptions.


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