Medicare - Parts A, B, C, D

Medicare Part A:
Medicare Part A covers a wide range of hospitalization and inpatient services. Most people get Part A automatically when they turn 65, or 24 months after they become disabled.  There is no premium for Medicare Part A if you or your spouse have worked 40 quarters or more (10 years total).  If you and your spouse have worked less than 10 years, you will have a Part A premium.

Medicare Part B: 
Medicare Part B helps pay for doctors’ services, outpatient, and other medically necessary services that aren’t covered under Part A. Some preventative services are also covered, but annual physicals are not. Unlike with Part A, nearly everyone pays a premium for Part B.  Home Infusion & DME services that are covered, fall under this category.

Medicare Part C: 
Medicare part C is also known as Medicare Advantage, is Medicare administered through private insurance companies.  Part C works somewhat differently than Original Medicare (Part A and Part B), but, by law, it is at least as good as Original Medicare.  Part C often includes all elements of original Medicare plus Part D, or prescription drug coverage.  They typically have their own fee schedule and contracts as it relates to covered services for Home Infusion and DME.  Most Medicare Advantage plans do cover home infusion & DME services, but most also require that you are contracted with them.  It is wise to fully investigate before servicing new patients that have Medicare Advantage plans.

Medicare Part D: 
Part D, the most recent addition to Medicare, provides prescription drug coverage to Medicare recipients.  Part D is available only through private insurance companies, either as an Integrated Medicare Advantage Part D Prescription Drug Plan (MA-PD) or a standalone Prescription Drug Plan (PDP).  While many home infusion drugs are covered through Part D, coverage is based on the NDC of the drug.  In many instances one vial size is covered and one is not.  Furthermore, Part D does NOT cover any related supplies.

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