Overview

Original Medicare is comprised of Part A (hospital insurance) and Part B (medical insurance). Medicare Part C (also called Medicare Advantage) is an alternative to Original Medicare sold by private  insurance companies; it typically offers additional benefits. Medicare Supplement (also called Medigap) fills in some of Original Medicare's coverage gaps, but cannot be combined with Medicare Advantage. Medicare Part D provides prescription drug coverage.

    Benefit Period

    is the way the Original Medicare program measures your use of inpatient hospital and skilled nursing facility (SNF) services. It begins the day that you enter a hospital or SNF and ends when you have not received inpatient hospital or Medicare-covered skilled care in a SNF for 60 days in a row.
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  • What is Medicare Part A?

    Short Answer:

    Medicare Part A is the hospital insurance portion of Original Medicare (Parts A & B).

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    Part A covers such things as:

    • Room and board in a hospital
    • Admission to a skilled nursing facility (care provided must be more than just custodial care)
    • Nursing home care for a limited amount of time as long you need medically necessary care, not just help with activities of daily living
    • Hospice care
    • Home health services (for more than assistance with basic daily activities)
  • What is Medicare Part B?

    Short Answer:

    Medicare Part B is the medical insurance portion of Original Medicare (Parts A & B). That means Part B covers things like doctors’ visits, outpatient care, ambulance services, certain home health care, medical equipment, physical therapy, and more.

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    Part B also covers a variety of preventive services, including cancer screenings, flu shots, screenings for other diseases, and yearly wellness visits. These services are free as long as your health care provider accepts Medicare.

    For non-preventive services, you must meet a Part B deductible, which is $183 in 2018. Once you have, you may be responsible for 20% of the Medicare-approved cost of the service.

    Find out if services, tests, or other items are covered here.

  • What is Medicare Part C?

    Short Answer:

    Medicare Advantage (Part C) is an alternative to Original Medicare (Parts A & B) that is offered by private insurers. It must cover everything that Original Medicare covers. Most Medicare Advantage plans offer additional features, such as vision, dental, and prescription drug coverage (Part D).

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    While Original Medicare is administered by the government, Medicare Advantage is the blanket term for plans that are sold by private insurers.

    Medicare Advantage plans are required to cover all of the services that Original Medicare covers, but they often layer on more benefits.

    For instance, while Original Medicare might cover only doctor and hospital visits, a Medicare Advantage plan might include vision, hearing, dental, and prescription drugs as well. Some may even include fitness or wellness benefits.

    Here are some important differences between Medicare Advantage and Original Medicare:

    • Medicare Advantage plans have yearly limits on your out-of-pocket costs.
    • Medicare Advantage plans may limit you to using health care providers who are in-network.
    • Medicare Advantage plans usually don’t cover care you receive outside of the U.S.
    • If you have Original Medicare, you can add a Medicare Supplement (Medigap) plan to help limit your out-of-pocket costs. You cannot, however, have both Medicare Advantage and a Medicare Supplement plan.

    Before joining a Medicare Advantage plan, be sure to find out what it covers, along with any estimated costs for services or prescription drugs.

    Medicare Advantage plans operate as HMO or PPO networks, meaning you should also check with your primary care physician (PCP) and any specialists you see to find out if they are in your HMO or PPO network before you select a plan. You can learn more at Medicare.gov/find-a-plan.

    You’re eligible for Medicare Advantage if you have Original Medicare, you live in the plan’s service area, you don’t have end-stage renal disease (except in certain situations), and you’re a U.S. citizen or lawful permanent resident.

  • What is Medicare Part D?

    Short Answer:

    Medicare Prescription Drug Plans (Part D) are the part of Medicare that covers prescription drugs. The plans are available to anyone who is eligible for Medicare.

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    Many people add a Medicare Prescription Drug Plan (PDP), or Part D, when they first sign up for Original Medicare (Parts A & B). Not buying a plan at that time could prove costly down the road.

    If you don’t sign up for a drug plan when you first become eligible or have creditable coverage from another source, you’ll have to pay a penalty if you decide to enroll later. That penalty is 1% of the "national base beneficiary premium" ($35.02 in 2018) for every full month you don’t have coverage.

    As long as you don’t go 63 days in a row without creditable coverage, you won’t have to worry about a Part D penalty. Your insurer should be able to tell you if your coverage qualifies.

    Or, if you receive what’s called “Extra Help”—a program designed to assist people with limited income and resources with drug plan costs—you are typically exempt from paying the late enrollment penalty.

    Many Medicare Advantage (Part C) plans include prescription drug coverage. These are often referred to simply as Medicare Advantage Prescription Drug (MAPD) plans.

    Finally, if you have prescription drug coverage through your employer or union, you may lose that coverage if you sign up for Medicare Part D. Check with them before making changes to your plan.

  • What is Medicare Supplement?

    Short Answer:

    Medicare Supplement (Medigap) plans are offered by private insurers to help pay for out-of-pocket costs that Original Medicare (Parts A & B) doesn’t cover. Generally speaking, Original Medicare covers about 80% of your costs, and Medicare Supplement plans are meant to help insure you for that remaining 20%.

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    There are ten Medicare Supplement plan options: A, B, C, D, F, G, K, L, M, and N. The plans are standardized across all states, except for Massachusetts, Minnesota, and Wisconsin. Because the plans are standardized, a Plan G from one insurer, for example, will be identical to a Plan G from another. However, the monthly premiums may vary since those are set by the insurers.

    Anyone who has Original Medicare (Parts A & B) is eligible for a Medicare Supplement plan. You pay the private insurer that administers your plan a monthly premium. This is in addition to the Part B premium that you pay to Medicare.

    Here are some other things to note about Medicare Supplement plans:

    • A plan covers only one person. If you and your spouse want Medicare Supplement plans, you’ll have to purchase two separate policies. But if you both buy from the same company, the insurer will typically give you a 5% discount on your monthly premiums.
    • It’s best to sign up for a Medicare Supplement plan during your Medicare Supplement Open Enrollment Period, which is a six-month window that begins on the first day of the month in which you’re 65 and enrolled in Medicare Part B. If you wait until after open enrollment ends, you may not be able to enroll in a plan, you may pay a higher premium, or you may face a pre-existing conditions clause that may last up to six months or more. (There are exceptions for those who don’t enroll in Part B when they’re first eligible because they’re covered by an employer group plan.)
    • You can’t have both a Medicare Supplement plan and Medicare Advantage (Part C), and it is illegal for insurers to sell you a Medicare Supplement plan if you have Medicare Advantage.