The Parts of Medicare

Medicare has 4 different parts – Parts A, B, C, and D. Each part of Medicare covers a portion of your overall healthcare. However, you will never need all four parts at the same time.

For starters, Medicare Parts A and B are called “Original Medicare” because these were the original parts of the Medicare program when it began in 1965. Part A is hospital insurance, and Part B is medical insurance.

Part C, or Medicare Advantage, was not introduced until 2003, and Part D, or prescription drug plans, was not introduced until 2006.‍

Medicare Part A is your hospital insurance. It covers expenses that occur in a hospital setting, such as inpatient care, as well as skilled nursing facility care, hospice care, and home health care.

Keep in mind that Part A doesn’t cover you indefinitely, and there are some eligibility hoops to jump through in order to qualify for the coverage that you do get.

Part A covers inpatient care if these 3 items are true:

1. You’re admitted to the hospital as an inpatient after an official doctor’s order, which says you need inpatient hospital care to treat your illness or injury.
2. The hospital accepts Medicare.
3. In certain cases, the Utilization Review Committee of the hospital approves your stay while you’re in the hospital.

For skilled nursing facility care, you also have a slew of requirements to meet, and Part A only covers the first 20 days. Days 21-100 are partially covered, and you are responsible for the full cost after Day 101.

Medicare Part A does not cover long-term care stays.

Medicare Part B is your medical insurance. If services or supplies are medically necessary or you’re getting a preventative service, Part B will cover it most of the time.

Part B covers things like medical equipment, an ambulance, office visits, screenings, flu shots, and clinical research.

Rest assured that if Part B does not cover a service or supply you need, you’ll be asked to sign a form stating that you’re responsible for the cost. You should never be blindsided by an unexpected medical bill.

Medicare Part C is more commonly known as Medicare Advantage, or MA for short. Medicare.gov refers to these plans as “Medicare health plans” that are offered by private insurance companies.

You’ve probably seen ads for Medicare Advantage plans offered by well-known companies like Aetna, Humana, and UnitedHealthcare. The insurance companies contract with Medicare to provide you at least the same coverage as Original Medicare. That means that MA plans are a replacement for Original Medicare, so you wouldn’t have both.

Many MA plans offer additional coverage beyond what Original Medicare provides, like dental, vision, and hearing benefits as well as free gym memberships.

Learn more about Medicare Advantage plans

Medicare Part D is prescription drug coverage. If you choose a Medicare Advantage plan, it may come with drug coverage in which case you wouldn’t need a Part D plan.

Each Part D plan is a little different, which is why you want to run a Part D comparison each year. Each plan has its own “formulary,” or a list of prescription drugs they will cover.

From there, different drugs in the formulary are placed into tiers, and each tier costs a different amount.

For example, Tier 1 drugs would be the least expensive (common, generic drugs), whereas Tier 4 might be the most expensive (brand name or specialty drugs).

Each year during the Annual Enrollment Period – October 15-December 7 – you have the opportunity to run a Part D plan comparison. Plans change each year, so you want to make sure that your drugs are still covering the medications you take.

Learn more about Medicare Part D plans

Many individuals get confused because they’ve heard of F, G, N, and perhaps other letters as well.

These are not parts of Medicare – they are Medicare Supplement plans. Medicare Supplement Plans are also organized by letters (how convenient, right?!).

There are 11 Medicare Supplement Plans (also called Medigap Plans):

• Plan A
• Plan B
• Plan C
• Plan D
• Plan F
• High-Deductible Plan F
• Plan G
• Plan K
• Plan L
• Plan M
• Plan N

Most of these plans will never affect you since there are only 2-3 that we recommend. However, it can get confusing, so we wanted to take a quick moment to explain the difference between Medicare “parts” and Medigap “plans.”

Get a Free Medicare Planner

If you want to learn more about the parts of Medicare, how they will affect your own health insurance, and what kind of coverage you may need, schedule a free consultation with us today.

We can provide you with a free Medicare planner that will give you a zoomed-out look at your needs when it comes to Medicare.

Call us at 217-423-8000 to schedule your free Medicare Planner consultation today. You can also schedule your consultation using our online scheduling system.