Medicare Coverages

Medicare Coverage Parts

If you’re eligible for Medicare and ready to explore your options, the first step is to get to know its four parts: A, B, C and D. Each part represents a different kind of coverage. This allows you to choose which parts you want and avoid duplicating coverage from other insurance plans.

Part A: Also called hospital insurance, Part A helps pay the costs of a stay in a hospital, skilled nursing facility, home health care, hospice care, and medicines administered to inpatients. Most people are enrolled automatically in Part A when they reach age 65.

Part B: Also called medical insurance, Part B helps pay bills for physicians and outpatient services such as rehab therapy, lab tests, ambulance services and durable medical equipment (DME). It also covers doctors' services in the hospital and most medicines administered in a doctor's office. It’s common for people to be automatically enrolled in Part B, too.

Part C: This part is an alternative way you can choose to receive your Medicare benefits. It consists of a variety of private health plans, known as Medicare Advantage plans (mainly HMOs and PPOs) that cover Part A, Part B and often Part D services in one package. This plan gives you all the benefits you get with traditional Medicare, and possibly more.

Part D: This part helps pay the cost of prescription drugs that you use at home, plus insulin supplies and some vaccines. To get this coverage, you must enroll in a private Part D drug plan or in a Medicare Advantage plan that includes Part D drugs. Each insurance company that offers a Part D plan decides which drugs it will cover and what they will cost. You need to decide whether to get Part D coverage as soon as you're eligible. If you wait, you may have to pay a penalty for joining late.

Selecting your Medicare Coverage Plan

It is important to understand your Medicare coverage choices and to pick your coverage carefully. When you first enroll in Medicare and during certain times of the year, you can choose how you get your Medicare coverage. There are 2 main ways to get your Medicare coverage—Original Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C). Some people need to get additional coverage, like Medicare prescription drug coverage or Medicare Supplement Insurance.

How you choose to get your benefits and who you get them from can affect your out-of-pocket costs and quality of care. In Original Medicare, you are covered when you go to nearly all doctors and hospitals in the country. On the other hand, Medicare Advantage Plans typically have network restrictions i.e. you will likely be more limited in your choice of doctors and hospitals. However, Medicare Advantage Plans can also provide additional benefits that Original Medicare does not cover, such as routine vision, hearing tests or dental care.