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Medicare: How it works
The Different Parts of Medicare

Medicare is health insurance for people age 65 or older, under 65 with certain disabilities, and any age with End-Stage Renal Dis- ease (ESRD). ESRD is permanent kidney failure requiring dialy- sis or a kidney transplant. The different parts of Medicare help cover specific services if you meet certain conditions.

Medicare has the following parts:

Medicare Part A
(Hospital Insurance)

Helps cover inpatient care in hospitals (includes critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals).

Helps cover skilled nursing facility (not custodial or long-term care), hospice, and home health care services.

See More About Medicare Part A Insurance

Medicare Part B
(Medical Insurance)

Helps cover doctor services & outpatient care.

Helps cover some preventive services to help maintain a person’s health and to keep certain illnesses from getting worse.

Generally pays 80% of the Medicare-approved amount for covered services

See More About Medicare Part B Insurance

Medicare Part C
(Medicare Advantage Plans)

A way to get Medicare benefits through private companies approved by and under contract with Medicare.

Includes Part A, Part B, and usually other benefits Medicare doesn’t cover. Most plans also provide prescription drug coverage.

See More About Medicare Part C Insurance

Medicare Part D
(Prescription Drug Coverage)

Run by private companies approved by Medicare, which can either be Medicare Advantage Plans or separate Medicare Prescription Drug Plans.

Helps cover the cost of prescription drugs.

Each plan can vary in cost and drugs covered.

See More About Medicare Part D Insurance

There are Two Main Choices for How You Get Your Medicare
Follow These Steps to Help You Decide:

Decide if You Want Original Medicare or a Medicare Advantage Plan

STEP 01

Original Medicare

Medicare Advantage Plan
(like and HMO or PPO)

Part A (Hospital Insurance)
and Part B (Medical Insurance)

Part C – Includes BOTH Part A (Hospital
Insurance) & Part B (Medical Insurance)

Medicare provides this coverage.

You have your choice of doctors, hospitals, and other providers.

Generally, you or your supplemental coverage pay deductibles and coinsurance.

You usually pay a monthly premium for Part B.

Private insurance companies approved by Medicare provide this coverage.

In most plans, you need to use plan doctors, hospitals, and other providers or you pay more or all of the costs.

You usually pay a monthly premium (in addition to your Part B premium) and a copayment or coinsurance for covered services.

Costs, extra coverage, and rules vary by plan.

STEP 02

Decide If You Want Prescription Drug Coverage (Part D)

If you want this coverage, you must choose and join a Medicare Prescription Drug Plan.

These plans are run by private companies approved by Medicare.

STEP 03: Decide If You Want Supplemental Coverage

You may want to get coverage that fills gaps in Original Medicare coverage. You can choose to buy a Medigap (Medicare Supplement Insurance) policy from a private company.

Costs vary by policy and company.

Employers/unions may offer similar coverage.

If you want prescription drug coverage, and it’s offered by your plan, in most cases you must get it through your plan.

If your plan doesn’t offer drug coverage, you can choose and join a Medicare Prescription Drug Plan.

Note: If you join a Medicare Advantage Plan, you don’t need a Medigap policy. If you already have a Medigap policy, you can’t use it to pay for out-of-pocket costs you have under the Medicare Advantage Plan. If you already have a Medicare Advantage Plan, you can’t be sold a Medigap policy.

In addition to Original Medicare or a Medicare Advantage Plan, you may be able to join other types of Medicare health plans.

You may be able to save money or have other choices if you have limited income and resources.

You may also have other coverage, like employer or union, military, or Veterans’ benefits.

Do you still feel like you need some advice?

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