Medicare by the Letters
When it comes to Medicare, 'A' is not for 'Apple,' though if we ate an apple a day, we would hope we wouldn’t need Part A, which is inpatient hospital coverage.
This article will outline the various parts of Medicare and explain in a general way which types of services are covered under each. Let’s start with Part A.
What Is Part A?
Part A includes inpatient hospital, skilled nursing facility (or SNF), nursing home, hospice and home health services care. It also includes long-term care acute care (LTAC). Part A Medicare claims are processed by the local Medicare Administrative Contractor for your state. Railroad Medicare processes your Part B claims, while your local Medicare Administrative Contractor handles your Part A claims.
What is Part B?
Part B services include medically necessary services and preventive services provided by doctors/physicians/surgeons and practitioners (such as nurse practitioners, physician assistants, qualified clinical psychologists, clinical social workers, certified midwifes and certified registered nurse anesthetists). Other providers and suppliers in the Part B program include chiropractors, podiatrists, ambulance services, and laboratories. Claims for these types of services are processed by Railroad Medicare/Palmetto GBA in Augusta, GA.
Because Railroad Medicare cards and 'regular' Medicare cards look very similar providers may have confusion about where to send your Part B claims.
Part B Claims for Railroad Medicare should be sent to:
Palmetto GBA Railroad Medicare
P.O. Box 10066
Augusta, GA 30999
What is Part C?
Part C is Medicare Advantage plans, such as Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO). These plans are offered by private companies that contract with Medicare to cover your Part A and B benefits. Most Part C plans replace traditional Part A and Part B. Other Medicare Advantage Plans include:
- Private Fee-For-Service (PFFS) – PFFS are offered by private insurance companies and let you receive health care from any doctor or other health care provider or hospital in the PFFS plan. Prescription drug coverage may also be offered by a PFFS plan.
- Special Needs Plans (SNP) – SNP limits membership to patients with specific illnesses and customizes their benefits to serve the needs of their members. For more information on SNP, please visit www.Medicare.gov.
- Medical Savings Accounts (MSA) – MSAs have a high deductible and in many cases only pays for covered Part A and B services once you have reached your deductible. The plan deposits funds (which typically are less than the deductible) into a designated account to pay for your health care services during the year.
What is Part D?
Part D is coverage for prescription drugs, and like Part C, the program is administered by private insurance companies. Part D plans have their own list of covered medicines, with a tiered pricing system. This means that some drugs, such as generics, may be in the lowest tier and have the lowest copayment. Drugs in the highest tiers would have the highest copayment. If you sign up for a Part D plan when you are first eligible you avoid paying a penalty. A penalty would be assessed if you don’t join when you were first eligible and you don’t have other drug coverage or don’t receive 'extra help'. Beneficiaries with limited income and assets may qualify for 'extra help' to help pay for prescription drugs. This program is administered through the Social Security program and Medicare. For more information, please visit www.SSA.gov/prescriptionhelp/.
DMEPOS stands for Durable Medical Equipment, Prosthetics, Orthotics and Supplies. DMEPOS would include items such as walkers, wheelchairs, diabetic shoes, and hospital beds, to name but a few. Claims for these and many more products are filed to regional Durable Medical Equipment (DME) Medicare Administrative Contractors. Railroad Medicare doesn’t handle claims for most DME items.
An Example of How the Letters Work Together
An example of how one procedure is covered by multiple parts of Medicare is for individuals receiving a cardiac pacemaker. The actual pacemaker (which is a DMEPOS - prosthetic device) is billed to your local DME Medicare Administrative Contractor. Hospital charges fall under your Part A benefit, and the physician’s fee, including post-surgical care, is billed to Part B. The oral medications you are prescribed to take after the procedure fall under your Part B benefit.
If You Have More Questions
If you have any questions about your Railroad Medicare (Part B) claims, please call our Beneficiary Contact Center at 800-833-4455, Monday through Friday, 8:30 a.m. until 7 p.m. ET. For the hearing impaired, call TTY/TDD at 877-566-3572. This line is for the hearing impaired with the appropriate dial-up service and is available during the same hours Customer Service Advocates are available.
If you would like more information about the general Medicare program, or specifically about Part C or Part D, you can contact your local State Health Insurance Counseling and Assistance Program, or SHIP. SHIP is a free program offered by all 50 states, as well as Guam, Puerto Rico and the Virgin Islands. SHIP counselors can help you learn more about the Medicare program and Medicare supplemental plans, as well as other long-term insurance options. To find a SHIP office for your state, please visit and enter 'SHIP' -State Health Insurance Assistance Program' and select your state. Or you may call 1-800-MEDICARE for more information.