Understanding Medicare Part A, B, and D Coverage

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Understanding Medicare Part A, B, and D
Coverage
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Understanding Medicare Part A, B, and D Coverage

• Basics of Medicare Part A, B, and D
• Most providers struggle with understanding exact
  coverage while billing for Medicare beneficiaries
  for part A, B or D coverage. In this article, we
  shared basics of Medicare coverage and services
  covered under every plan. It will help providers
  and billers to collect accurate patient
  responsibility at the time of service only. Lets
  begin with what Medicare part A, B, and D means
• Part A i.e., Hospital Insurance covers inpatient
  care in hospitals, skilled nursing facility care,
  hospice care, and home health care
• Part B i.e., Medical Insurance covers services
  from doctors and other health care providers,
  outpatient care, home health care, durable
  medical equipment (like wheelchairs, walkers,
  hospital beds, and other equipment), and many
  preventive services (like screenings, shots or
  vaccines, and yearly Wellness visits)
• Part D i.e., Drug coverage covers the cost of
  prescription drugs (including many recommended
  shots or vaccines). Plans that offer Medicare
  drug coverage (Part D) are run by private
  insurance companies that follow rules set by
  Medicare.
• Understanding of Medicare Coverage
• When beneficiary enrolls in Medicare and during
  certain times of the year, they can choose how to
  get Medicare coverage. There are 2 main ways to
  get Medicare

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Understanding Medicare Part A, B, and D Coverage
Original Medicare Original Medicare includes
Medicare Part A (Hospital Insurance) and Part B
(Medical Insurance). Beneficiaries can join a
separate Medicare drug plan to get Medicare drug
coverage (Part D). They can use any doctor or
hospital that takes Medicare, anywhere in the
U.S. To help pay out-of-pocket costs in Original
Medicare (like 20 coinsurance), they can also
shop for and buy supplemental coverage. They can
also add supplemental coverage. This includes
Medicare Supplement Insurance (Medigap). With
original Medicare, in most cases, you dont need
a referral to see a specialist. Original
Medicare covers most medically necessary services
and supplies in hospitals, doctors offices, and
other health care facilities. Original Medicare
doesnt cover some benefits like eye exams, most
dental care, and routine exams. As mentioned
earlier, separate Medicare drug plan might
require to get Medicare drug coverage (Part D).
In most cases, beneficiary dont have to get a
service or supply approved ahead of time for
Original Medicare to cover it. Medicare
Advantage Medicare Advantage which also known as
Part C is a Medicare-approved plan from a private
company that offers an alternative to Original
Medicare for your health and drug coverage. These
bundled plans include Part A, Part B, and
usually Part D. These plans may have lower
out-of-pocket costs than Original Medicare. Plans
may offer some extra benefits that Original
Medicare doesnt cover like vision, hearing, and
dental services. For Medicare advantage, in many
cases, beneficiaries need to only use doctors and
other providers who are in the plans network
(for non-emergency care).
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Understanding Medicare Part A, B, and D Coverage
Some plans offer non-emergency coverage out of
network, but typically at a higher cost. Medicare
Advantage may need to get a referral to see a
specialist. Medicare advantage plans covers all
of the medically necessary services that original
Medicare covers. As mentioned above, most plans
offer some extra benefits that Original Medicare
doesnt cover like some routine exams and vision,
hearing, and dental services. In some cases,
prior approval is needed to get a service or
supply for the plan to cover it. Medicare drug
coverage (Part D) is included in most plans. In
most types of Medicare Advantage Plans, there is
no need to join a separate Medicare drug
plan. Legion Health Care Solutions is a leading
medical billing company that can assist you in
revenue cycle functions for your practice. If you
are having any trouble billing for Medicare,
Medicaid, other government payers or private
payers, we can assist you. Our expert medical
billers and coders follows updates billing and
coding guidelines to receive timely insurance
reimbursements. Please call us to know more about
our billing and coding services at 727-475-1834
or email us at info_at_legionhealthcaresolutions.com
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