Medicare is the federal health insurance program for:

  • People who are 65 or older
  • Certain younger people with disabilities
  • People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

The different parts of Medicare help cover specific services:

Medicare Part A (Hospital Insurance)

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. There are no “networks”  of hospitals to you must adhere to; as long as the provider accepts medicare, you can use that provider or facility. Part A is does not have a monthly premium.

BENEFITS

  • Inpatient hospital care (such as critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals)
  • Inpatient care in a skilled nursing facility (not custodial or long term care)
  • Hospice care services
  • Home health care services

Medicare Part B (Medical Insurance)

Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.  There is no network of doctors that you have to adhere to and you never need a referral.  You are paying a separate amount for each service and that is why getting a Medicare Supplement ( Medigap plan) is so important. Part B has a monthly premium which is usually deducted from your monthly social security payment.

BENEFITS

Medicare Part B covers a portion of:

  • Doctors’ services
  • Outpatient hospital care
  • Laboratory tests
  • Outpatient physical therapy
  • Outpatient speech therapy
  • Certain home health care
  • Certain ambulance services
  • Certain medical equipment and supplies

Medicare Part D (prescription drug coverage)

Part D adds prescription drug coverage to:

  • Original Medicare
  • Some Medicare Cost Plans
  • Some Medicare Private-Fee-for-Service Plans
  • Medicare Medical Savings Account Plans

These plans are offered by insurance companies and other private companies approved by Medicare. These plans have a monthly premium. You can add these plans to Original Medicare. If you are purchasing a Medicare Advantage Plan it may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans. If you are using Original Medicare (or Medicare Advantage Plan of PFFS/ MSA types), use a stand-alone Medicare Prescription Drug Plan (PDP). Alternatively, if you are enrolled into Medicare Advantage Plan of other types, you may use Medicare Advantage Prescription Drug Plan (MA-PD) with Prescription Drug Plan as a part of Medicare Advantage. See our Part D page for more details.

Medicare Part C (Medicare Advantage)

Part C is an alternative to Original Medicare (Part A and Part B), you may decide to enroll yourself into Medicare Part C  also known as a Medicare Advantage Plan.  These plans are offered by private insurance companies, and must be approved by Medicare. They combine Parts A and B and in some cases Part D. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan. Your Medicare services aren’t paid for by Original Medicare and each plan can include deductibles, copay and co-insurance and in some cases a monthly premium.