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PARTS OF MEDICARE
Medicare is a health insurance program structured into several parts, each designed to cover different approved healthcare expenses. Original Medicare, which includes Part A and Part B, is managed by the government, while the remaining parts are provided by private insurance companies that are approved by Medicare.
In this guide, we’ll provide a straightforward overview of the various Medicare parts, helping you understand the coverage options available with each.
Medicare Part A and Part B are collectively referred to as Original Medicare. Before you can enroll in any other Medicare parts, you must first sign up for Original Medicare. Part A provides coverage for inpatient medical services, including hospice care, skilled nursing facility care, hospital insurance, and certain home healthcare services.
While Part A offers significant benefits, it does come with some out-of-pocket expenses, such as deductibles, coinsurance, and copayments. Fortunately, most individuals do not have to pay premiums for Part A if they have contributed Medicare taxes during their employment. You can enroll in Part A during your Initial Enrollment Period, the General Enrollment Period, or automatically if you receive benefits from Social Security or the Railroad Retirement Board.
Part A
Part B
Medicare Part B is the second component of Original Medicare, offering coverage for a variety of outpatient medical services. This includes doctor visits, preventive screenings, durable medical equipment, lab tests, emergency room services, mental health care, and ambulance transportation. While Part A is typically premium-free for most beneficiaries, you will likely need to pay premiums for Part B, which can vary based on your income. If you receive Social Security benefits, your Part B premium can be automatically deducted from those payments.
In addition to premiums, there are out-of-pocket costs associated with Part B, such as deductibles, copayments, and coinsurance. After you meet the annual deductible, Part B covers 80% of the approved costs for covered services.
It’s crucial to enroll in Part B as soon as you become eligible, as there is a late enrollment penalty that can increase your premium if you delay enrollment during your Initial Enrollment Period. Although you can sign up during other enrollment periods, be aware that a penalty may apply unless you qualify for a Special Enrollment Period.
Medicare Advantage (Part C) plans are offered by Medicare-approved private insurance companies, unlike Medicare Part A and Part B. These plans combine the coverage of both Part A (hospital insurance) and Part B (medical insurance), ensuring you receive the same services as Original Medicare.
Many Medicare Advantage plans also offer additional benefits not included in Original Medicare, such as prescription drug coverage, routine dental, vision, hearing services, gym memberships, wellness programs, and more.
To be eligible for a Medicare Advantage plan, you must first be enrolled in Original Medicare.
Medicare Advantage (Part C)
Part D
Similar to Part C, Medicare Part D plans are offered by insurance companies that have contracts with Medicare. Part D provides standalone prescription drug coverage and can be used in conjunction with your Original Medicare. Additionally, it may also be included as an extra benefit in some Medicare Advantage plans.
Each Part D plan features a formulary, which is a list of covered medications. While the specific drugs included in each formulary may vary, there are certain classes of drugs that all plans must cover, including:
Anticancer medications
Antidepressants
Anticonvulsants
Antipsychotics
Immunosuppressants
HIV/AIDS treatments
Common vaccines
Medicare Supplement plans, commonly referred to as Medigap plans, are offered by private insurance companies to help cover out-of-pocket expenses that Original Medicare typically does not cover. These costs may include deductibles, coinsurance, copayments, and more. Each Medigap plan provides varying levels of coverage for these expenses, and there are ten different plans available for you to explore: Plans A, B, C, D, F, G, K, L, M, and N.
To learn more about each aspect of Medicare and how these plans can benefit you, contact us today. We are here to ensure you stay well-informed about all your coverage options.
Medicare Supplement
Frequently Asked Questions
New to Medicare?
What is Medicare and How Do I Qualify?
Medicare Advantage plans are offered by private insurance companies contracted through Medicare as an alternative to Original Medicare. These plans combine all of the benefits of Medicare Part A (hospital) and Part B (medical), and may also include prescription drug coverage, if they are Medicare Advantage Prescription Drug Plans.These plans combine all of the benefits of Medicare Part A (hospital) and Part B (medical), and may also include prescription drug coverage, dental or vision coverage all for an affordable and sometimes $0 monthly plan premium.
What is Medicare Advantage (Part C)?
Medicare Advantage plans are offered by private insurance companies contracted through Medicare as an alternative to Original Medicare. These plans combine all of the benefits of Medicare Part A (hospital) and Part B (medical), and may also include prescription drug coverage, if they are Medicare Advantage Prescription Drug Plans. These plans combine all of the benefits of Medicare Part A (hospital) and Part B (medical), and may also include prescription drug coverage, dental or vision coverage all for an affordable and sometimes $0 monthly plan premium.
What are Medicare Prescription Drug Plans (Part D)?
Medicare Part D plans add prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans. A prescription drug plan may help you save money on existing prescriptions or on medication needs in the future.
Not affiliated with the United States government or federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
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