While Medicare is broken down in to four different parts; A, B, C, and D, there are a number of plans for someone to choose from under Medicare. Medicare is health insurance provided by the government, not private insurance companies. Someone becomes eligible for Medicare if they are 65 years of age or older, under 65 and receiving disability payments, or if they have permanent kidney damage requiring dialysis. The most basic of plans is the Original Medicare Plan. This plan includes type A, hospital coverage, and type B, basic medical coverage.  An individual will pay a deductible each year, which must be met before the government starts to pay, and co-payments at the time of service. Part B is optional, and if used, the member is subject to a monthly premium as well.

Medicare part C is actually a plan in itself. These plans are called Medicare Advantage Plans. They work like HMO’s and PPO’s.  Such plans include parts A and B and cover extra services outside of the Original Plan, such as dental care, vision care and gym or health club memberships. With an Advantage plan, any medically-necessary service must be covered. Most Advantage Plans also include part D, which is prescription drug coverage. Members of part C are also insured against catastrophic costs over $5,000 and usually have a portion, or all, of their parts B and D premiums refunded.

Part D of Medicare is prescription drug coverage. Someone can have solely a prescription drug plan, of which there are thousands to choose from, based on the drugs needed, a member’s location, and preference of generic or brand-name drugs. A Prescription Drug Plan Finder can be used to find the best plan for an individual.

The rarest form of Medicare is the Medigap plan. It covers some of the holes not filled by the Original Plan, such as providing emergency care outside of the U.S., and in some cases, helping with prescription drug costs. These plans are set up through private insurance companies, which then share the costs with the government.

Part B of Medicare covers many of the areas that are not covered by Medicare part A. Individuals are qualified to receive part B if they are receiving Social Security disability payments for 24 months, Social Security retirement payments, or if they are entitled to Medicare part A . When your Medicare card is sent, you have the option to deny Medicare B coverage. However, you can enroll in part B during the open enrollment period for no charge or at any other time, if eligible, and by paying a fee. Part B covers physicians’ services, outpatient visits, x-rays , medical equipment and similar services.

1. Physicians’ services;

2. Home Health Care;

3. Services and supplies, including drugs and biologicals which cannot be self-administered, furnished incidental to physicians’ services;

4. Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests;

5. X-ray therapy, radium therapy and radioactive isotope therapy;

6. Surgical dressings, and splints, casts and other devices used for fractures and dislocations;

7. Durable medical equipment;

8. Prosthetic devices;

9. Braces, trusses, artificial limbs and eyes;

10. Ambulance services;

11. Some outpatient and ambulatory surgical services;

12. Some outpatient hospital services;

13. Some physical therapy services;

14. Some occupational therapy;

15. Some outpatient speech therapy;

16. Comprehensive outpatient rehabilitation facility services;

17. Rural health clinic services;

18. Institutional and home dialysis services, supplies and equipment;

19. Ambulatory surgical center services;

20. Antigens and blood clotting factors;

21. Qualified psychologist services;

22. Therapeutic shoes for patients with severe diabetic foot disease;

23. Influenza, Pneumococcal, and Hepatitis B vaccine;

24. Some mammography screening;

25. Some pap smear screening, breast exams, and pelvic exams;

26. Some other preventive services including colorectal cancer screening, Diabetes training tests, bone mass measurements, and prostate cancer screening.

Medicare B does not cover the following services:

1. Services which are not reasonable or necessary;

2. Custodial care;

3. Personal comfort items and services;

4. Care which does not meaningfully contribute to the treatment of illness, injury, or a malformed body member;

5. Prescription drugs which do not require administration by a physician;

6. Routine physical checkups;

7. Eyeglasses or contact lenses in most cases;

8. Eye examinations for the purpose of prescribing, fitting, or changing eyeglasses or contact lenses;

9. Hearing aids and examinations for hearing aids;

10. Immunizations except for influenza, pneumococcal and hepatitis B vaccine;

11. Cosmetic surgery;

12. Most dental services ;

13. Routine foot care

Medicare B covers 80% of medical fees, based on what Medicare considers a "reasonable charge" for a certain service. If there is a discrepancy between a doctor’s fee and the "reasonable charge" the patient is responsible for the difference. However, the provider is not legally allowed to charge more than 115% of the "reasonable charge". The biggest complaint about Medicare B is the out-of-pocket expenses. The monthly premium for part B is based on income and is between $96.40 and $238.40. There is also a $135 deductible, meaning that the patient must pay $135 for services before Medicare will start to cover its 80%.