Barry D. Weiss, MD, College of Medicine, University of Arizona
March 2019
TIPS ABOUT MEDICARE
- Be aware of your patients' Medicare coverage. Are they in a Medicare Advantage Plan in which they must see providers with a defined network, or can they see any provider who accepts Medicare?
- Be aware that for Medicare Part D, which provides drug coverage, the copay for medication can vary considerably depending on whether the medication is classified as Tier 1, 2, 3, 4 or 5. Tier-1 and Tier-2 medications are much less costly, sometimes only a few dollars per prescription. Tier-4 and Tier-5 medications can cost hundreds of dollars.
Medicare is a US government-sponsored program that provides health insurance coverage for adults over 65 and qualified individuals with disabilities. This issue of Elder Care will focus on Medicare for older adults.
The Medicare program has evolved since the first enrollees began receiving coverage in 1966. Part of that evolution has been the introduction of different categories of coverage, known as Parts A, B, C, and D (Table 1).
There are now two types of Medicare programs: "original Medicare," which is the standard program that has existed since the program began, and "Medicare Advantage Plans." Advantage Plans are governed by Part C.
Table 1. Parts A, B, C, and D of Medicare
|
Part |
Services Covered |
|
A |
Hospital care, skilled nursing facility care, hospice, home health services, nursing home care (as long as custodial care is not the only care required) |
|
B |
Doctor visits, lab tests, medical supplies and equipment, certain preventive services, ambulance transport, inpatient and outpatient mental health care, second opinions before surgery |
|
C |
Medicare Advantage Plans |
|
D |
Prescription Drugs |