The Different Parts of Medicare

Medicare parts A and B provide complete protection or comprehensive coverage. Many Americans believe the combination offers complete protection. This isn’t the case.

While many people have both parts A and B of Medicare, they are making a mistake by thinking that they have complete protection. What they have is comprehensive coverage, but this is not the same thing as complete protection.

If you go back a bit in history, Medicare has never covered outpatient prescription costs, with the onetime exception in 1989. Things mostly remained that way until 2003 when a new act was brought into force – the Medicare Prescription Drug Improvement and Modernization Act. All that whole mouthful means is that it expanded Medicare to include a prescription drug benefit that started in 2006.

You might be wondering why the change wasn’t implemented earlier. This has to do with the fact that Medicare has the right to definitively outline the care it will cover, and that includes part D. This brings up another interesting point, the one that says all medical treatments and procedures must be approved by Medicare. This is the major reason why you need to have a good working knowledge of Medicare to really understand the program.

Not many people seem to realize that every part of Medicare offers benefits for different types of care and that Medicare parts A and B each have different co-payments, out-of-pocket expenses and limits. What this really means is that you almost have two different insurance policies.

What do you need to know to have your medical expenses covered by Medicare? The first thing you need to know is that your treatment is medically required and deemed appropriate for the condition you have. Medicare must approve your treatment and it must have been prescribed by a doctor.

They won’t OK coverage of unique procedures or experimental treatments. If however you feel you have been wrongly denied, you do have the right to appeal the decision. Why is this stuff important for you to know? It is significant for you to know because Medigap and/or Medicare supplement insurance only pays a claim if Medicare accepts the expenses as reasonable.

Keep in mind that no matter where you buy Medicare plans and/or Medicare supplement plans, they are all the same, all standardized. The only differences will be what one company charges versus another. The thing to pay attention to is that since the plans were standardized, plan F has become the most popular because customers value the full coverage. This isn’t to say that there aren’t other viable alternatives such as plan C, D or G because many hospitals and physicians don’t demand the patient pay more than what Medicare approves.

Randy Gillespie is with Illinois health insurance agency, Focus Insurance Group. To learn more about Illinois health insurance, Illinois health insurance quotes, Illinois group health insurance or to get an Illinois health insurance quotes, visit

Tagged with: , ,