Medicare Part A vs Part B

Medicare Part A vs Part B

Medicare is a health insurance program for:

  • people age 65 or older,

  • people under age 65 with certain disabilities, and

  • people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

Medicare Part A vs Part B

Part A Hospital Insurance - Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.

Part B Medical Insurance - Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

Prescription Drug Coverage - Most people will pay a monthly premium for this coverage. Starting January 1, 2006, new Medicare prescription drug coverage will be available to everyone with Medicare. Everyone with Medicare can get this coverage that may help lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.

Medicare Part A vs Part B - Question

How will my retail pharmacy discount work with with my Medicare drug coverage?

If you enroll in a Medicare drug plan, you will have access to a long list of prescription drugs at discounted prices, but you can still benefit from retail pharmacy programs.

For example, if you have a Medicare drug plan that charges 25% coinsurance and you use the Wal-Mart pharmacy, you will have to pay only $1 (or 25% of $4) for the generic drugs covered by the Wal-Mart program. You will pay $4 for these medications if you are meeting a deductible or are in the coverage gap.

It is important to realize that these retail pharmacy programs do not cover all generic drugs nor do they typically cover any brand-name drugs, many of which do not have generic versions available. In addition, while you have the choice of getting your drugs at a number of pharmacies or by mail-order under the Medicare drug coverage, the retail pharmacy programs generally apply only to covered generics purchased at the retail pharmacy.

Enrolling in a Medicare drug plan will give you access to a larger list of prescription drugs at discounted prices in case you need a prescription drug that is not on a limited list of specially discounted generic drugs offered by a retail pharmacy. You will still benefit from discounts for selected generic drugs purchased at these retail pharmacies offering these special prices, but you will have broader coverage as well.

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