Medicare Summary

There are four different parts to Medicare. The following is a Medicare overview describing the four parts:

  • Medicare Part A (Hospital Insurance)

Helps cover inpatient hospital care and skilled nursing facilities as well as home health services and hospice.

If you or your spouse paid Medicare taxes while working, you generally do not pay a monthly premium for Part A coverage. You can also purchase Part A if you are over 65, enrolling in Part B, and meet American citizenship of residency requirements. Normally, if you decide to purchase Part A, you must also have Part B and must pay premiums for both services.

  • Medicare Part B (Medical Insurance)

Helps cover necessary doctor’s services, hospital outpatient care, home health care, and some preventative services

You pay a monthly premium for this part of original Medicare. If you already receive benefits from Social Security or the Railroad Retirement Board, you automatically enroll in part B in the month you turn 65. If you are under age 65 and disabled you automatically get Part B once you receive disability benefits from Social Security. In order to opt out of Part B, you must send the card back; otherwise you keep Part B and continue paying the Part B monthly premiums.

  • Medicare Part C (Medicare Advantage Plans)

Health plans offered by private companies approved by the Federal government but not regulated under Medicare. Part C will provide all of the services under Part A and Part B and most include Medicare Prescription drug coverage (Part D). Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs.

Most plans will have a premium in addition to the Part B premium. Medicare pays a fixed amount for services to companies offering private insurance options. These companies must follow rules set forth by Medicare but they can charge different out-of-pocket costs and can have different rules for how services are provided.

Most Medicare Advantage plans require you to use the doctors or hospitals on that plan’s network. Part C plans include Health Maintenance Organizations (HMOs), Preferred Provider Organization (PPO), Private Fee for Services (PFFS), Special Needs, or Medical Savings Account (MSA).

  • Medicare Part D (Prescription Drug Coverage)

The “prescription drug option” that is run by Medicare-approved private insurance companies. Helps cover the cost of prescription drugs.

This part of your Medicare benefits is optional and you will pay a separate monthly fee for it which will vary among insurers. You will share in the costs of your prescription drugs according to the specific plan you enrolled in. Those costs can include a deductible, a flat copay amount, or a percentage of the full drug cost (coinsurance).

If you have limited income and cannot afford your medications even with your Part D Medicare benefits, you may qualify for the Extra Help program for financial assistance with your monthly premium, deductible, copay or coinsurance.