Medicare Basics

What Are the Parts of Medicare?

Medicare has four parts. Part A covers hospital care. Part B covers doctor visits and outpatient care. Part C, also called Medicare Advantage, bundles Parts A and B into one private plan. Part D covers prescription drugs. Here’s what each part does and what it costs.

Medicare Part A

Medicare Part B

Medicare Part C

Medicare Part D

What Is Medicare Part A?

Medicare Part A is hospital insurance. It helps pay for care when you’re admitted as an inpatient.

What Does Part A Cover?

Inpatient hospital stays
Skilled nursing facility care (short-term, not
custodial or long-term care)
Hospice care
Some home health care

Part A covers your room and stay. Many of the treatments and doctor services you receive during a hospital stay fall under Part B.

How Much Does Part A Cost?

For most people, Part A is free. If you or your spouse paid Medicare taxes for at least 10 years while working, you won’t pay a monthly premium. If not, you may have to buy Part A.

What Is Medicare Part B?

Medicare Part B is medical insurance. It covers doctor visits, outpatient care, and preventive services.

Part B covers two types of services:

Medically necessary services: care and supplies needed to diagnose or treat a medical condition.

Preventive services: care that prevents illness or catches it early, like flu shots and screenings. Most are free when you see a provider who accepts Medicare.

Part B Also Covers

Ambulance services
Durable medical equipment, like walkers and wheelchairs
Mental health care
Outpatient care and partial hospitalization
Cancer treatment and dialysis
Some outpatient prescription drugs
Clinical research

How Much Does Part B Cost?

Part B has a monthly premium that Medicare sets each year. Most people pay the standard amount. People with higher incomes pay more, based on the income reported on their tax return from two years earlier.

Treatments like chemotherapy and dialysis can be very expensive. That’s why most people should enroll in Part B when they’re first eligible.

What Is Medicare Part C (Medicare Advantage)?

Medicare Part C, also called Medicare Advantage, is an all-in-one alternative to Original Medicare. These plans are offered by private insurance companies approved by Medicare. They include Part A and Part B coverage, and most also include Part D prescription drug coverage. With a Medicare Advantage plan, you still have Medicare.

Costs for Medicare Advantage Plans

What you pay in a Medicare Advantage Plan depends on several factors. In many cases, you’ll need to use doctors and other providers who are in the plan’s network and service area for the lowest costs. Some plans won’t cover services from providers outside the plan’s network and service area. Learn about these factors and how to get cost details.

Drug Coverage in Medicare Advantage Plans

Most Medicare Advantage Plans include prescription drug coverage (Part D). You can join a separate Medicare Prescription Drug Plan with certain types of plans that:

Can’t offer drug coverage (like Medicare Medical Savings Account plans)
Choose not to offer drug coverage (like some Private Fee-for-Service plans)
You’ll be disenrolled

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What Extra Benefits Do Medicare Advantage Plans Offer?

Many Medicare Advantage plans cover things Original Medicare doesn’t, such as:

Dental, vision, and hearing care
Fitness programs and gym memberships
Over-the-counter allowances
Rides to medical appointments

Some plans also offer special benefits for people with certain chronic conditions. Benefits vary by plan, so it’s important to compare before you enroll.

What Are the Rules for Medicare Advantage Plans?

Medicare pays private insurance companies a set amount each month to provide your care, and those companies must follow Medicare’s rules. Each plan can set its own costs and rules, including:

Whether you need a referral to see a specialist
Whether you must use doctors and hospitals in the plan’s network for non-emergency care

These rules can change every year, which is why reviewing your plan annually matters.

How Much Do Medicare Advantage Plans Cost?

Costs depend on the plan’s premium, deductibles, co-pays, and whether you stay in network. Many plans have a $0 monthly premium, though you still pay your Part B premium. Using doctors outside the network usually costs more, and some plans won’t cover out-of-network care at all.

Do Medicare Advantage Plans Include Drug Coverage?

Most do. Some plan types, like Medical Savings Account plans and some Private Fee-for-Service plans, don’t include it. With those, you can add a separate Part D plan. If you’re in a Medicare Advantage plan that already includes drug coverage and you join a separate Part D plan, you’ll be removed from your Medicare Advantage plan.

What Is Medicare Part D?

Medicare Part D is prescription drug coverage. It helps pay for the medications you take. Part D is optional, but most people should enroll when they’re first eligible, even if they don’t take prescriptions now.

There Are 2 Ways To Get Medicare Drug Coverage

1. Medicare Drug Plans.

These plans add drug coverage to Original Medicare, some Medicare Cost Plans, some Private Fee-for-Service plans, and Medical Savings Account plans. You must have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) to join a separate Medicare drug plan.

2. Medicare Advantage Plan (Part C) or other Medicare Health Plan With Drug Coverage.

You get all of your Part A, Part B, and drug coverage, through these plans. Remember, you must have Part A and Part B to join a Medicare Advantage Plan, and not all of these plans offer drug coverage.

Is There a Penalty for Not Enrolling in Part D?

Yes. If you skip Part D when you’re first eligible and go 63 days or more without other creditable drug coverage, you’ll likely pay a late enrollment penalty if you join later. Coverage through an employer or union, or Extra Help, can count. In most cases the penalty lasts as long as you have Medicare drug coverage.

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2833 West Lake Rd
Wilson, NY 14172

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chris@saratogamedicare.com
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