Medicare Definition

Medicare is a federal health insurance program designed for people age 65 years or older and people under 65 with certain disabilities or End Stage Renal Disease. Medicare is divided into four parts — Part A, Part B, Part C and Part D.

65 birthday cake with candles

Medicare Part A

Medicare Part A (also known as “Hospital Insurance”) provides benefits related to inpatient hospital care. It also helps pay for other services like skilled nursing facility care and hospice care. 

If you have paid payroll taxes for at least 10 years, you’ll receive Part A benefits without having to pay a premium.

If you’re 65 or older and are already receiving Social Security or Railroad Retirement Board benefits — or if you are disabled and meet certain criteria — you’ll receive Part A coverage automatically. If not, you’ll have to enroll, which we’ll learn more about in the eligibility section of this article.

Medicare Part B

Medicare Part B (also known as “medical insurance”) covers medically necessary services and preventive services related to general medical care, such as outpatient care, doctor visits, preventive services and medical supplies. 

This can also include:

  • Clinical research
  • Ambulance services
  • Durable medical equipment
  • Mental health
  • Second opinions before surgery
  • Some outpatient prescription drugs

There is a monthly premium for Part B. And as of 2019, the current premium is $135.50 (or higher depending on your income) per month. Part B also comes with a deductible of $185 per year in 2019, then after the deductible is met, you typically pay 20 percent of the Medicare-approved amount for services.**

Medicare Part A and Part B together are known as Original Medicare.

Medicare Part C

Medicare Part C (also known as Medicare Advantage) is a collection of private health insurance plans that is an alternative to Original Medicare. They include Original Medicare benefits and may include others, like prescription drug coverage, vision coverage and dental coverage.

You may elect to receive your Medicare benefits through a Medicare Advantage plan instead of through Original Medicare. Medicare Advantage plans resemble traditional health insurance plans — there may be a network of health care providers and you might need referrals to see specialists. Premiums, deductibles and out-of-pocket costs vary by plan.

Medicare Part D

Medicare Part D provides prescription drug coverage to Medicare recipients. If you have Original Medicare (or a Medicare Advantage plan that doesn’t offer drug coverage), you can buy a Prescription Drug Plan from a private insurance company to help you pay for your medications. If you’ve decided to enroll in a Medicare Advantage plan, keep in mind that many of them include Part D coverage (they are known as MA-PDs).

The costs associated with Part D coverage vary by plan.

Medicare eligibility

Generally speaking, to qualify for Medicare you must be 65 years old, have a certain disability, ALS or End Stage Renal Disease. You also have to be a citizen of the U.S or a permanent legal resident for at least five continuous years.

Medicare vs. Medicaid

It is important to note that Medicare and Medicaid are not the same — in fact, they serve different purposes. Medicaid is a program administered jointly by federal and state governments to provide health coverage to low-income individuals and families. Medicare provides health coverage for people 65 and older — or people with certain disabilities or medical conditions — regardless of income.

Sometimes, Medicaid can be used to help pay for certain Medicare costs, like your Part B premium.

Signing up for Medicare

If you’d like to learn more about enrolling in Medicare, visit the Social Security Administration’s website.

To find a Medicare Advantage plan in your area, call a licensed insurance agent at TTY Users: 711.

Copyright © 2018 TZ Insurance Solutions LLC. All rights reserved.

**Medicare.gov, “Medicare costs at a glance.” Published 2018. https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.