There are four different parts of Medicare: Part A, Part B, Part C, and Part D — each part covering different services. Understanding how these parts and services work (together and separately) is the key to determining which ones fit your unique health care needs and budget.
There are two main paths for Medicare coverage — enrolling in Original Medicare (Parts A and B) or enrolling in a Medicare Advantage plan (Part C). Either path can include prescription drug coverage (Part D). Find out if Medicare Advantage may be an attractive option for you.
Original Medicare — sometimes referred to as “traditional” Medicare — is administered by the federal government. It is divided into two parts: Part A (hospital insurance) and Part B (medical insurance).
Medicare Part A covers hospital care, including, skilled nursing facilities, hospice, and some home health care.
Medicare Part B is “optional” medical insurance that covers a range of outpatient services — including physician and specialist office visits, preventive care, lab work, medical equipment, physical therapy, mental health care and wellness visits.
Who is eligible?
Generally, you become eligible to receive Medicare benefits when you turn 65 years old ― assuming you meet certain citizenship or residency requirements. There are exceptions made to the age requirement for those with disabilities and End-Stage Renal Disease.
For those younger than 65, you are only eligible to receive Medicare benefits if you:
Some people qualify for automatic enrollment and others have to enroll.
If you’re already receiving Social Security or railroad retirement benefits — you’ll be enrolled in Part A and Part B automatically on your 65th birthday. If you’re under 65, it’s the 25th month you receive disability benefits.
ALS patients are automatically enrolled in Medicare coverage when their Social Security disability benefits begin, regardless of age. If you have end-stage renal disease (ESRD), you must manually enroll.
If you’re eligible for Medicare but don’t qualify for automatic enrollment, you can apply online, over the phone, or in person at your local Social Security office. If you worked for a railroad, you’ll need to contact the Railroad Retirement Board for information on enrollment.
Medicare Advantage (Part C) is an alternative to Original Medicare. It allows you to receive Part A and Part B benefits — and in many cases, other benefits — from a private health insurance plan.
At the very least, your Medicare Advantage plan must offer the same benefits as Original Medicare. The only exception is hospice care, which is still covered by Medicare Part A.
Additional benefits that many Medicare Advantage plans include are:
If you’re eligible for Medicare Part A and Part B, and do not have ESRD, you can join a Medicare Advantage Plan. Medicare beneficiaries have the option of receiving health care benefits through either Medicare Advantage or Original Medicare — but not both. You need to enroll in Part A and Part B to sign up for a Medicare Advantage plan.
Because private insurance companies offer Medicare Advantage plans, costs can vary between policies. They may have different premiums and out-of-pocket costs than Original Medicare. With a Medicare Advantage plan, you must pay your Part B premium in addition to the plan premium (if one exists).
Medicare Prescription Drug Coverage (Part D) helps cover your prescription drug costs. Prescription Drug Plans (PDPs) can be purchased as stand-alone plans from private insurers in addition to Original Medicare or Medicare Advantage plans that don’t offer drug coverage. Many Medicare Advantage plans include Part D coverage.
To learn more about your Medicare options — Part A, B, C or D — connect with a licensed insurance agent today. Call TTY Users: 711.