Medicare Parts Explained
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Serving clients since 2009
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The Different Parts of Medicare
There are different parts of Medicare to
help cover specific health care services:
Medicare Part A (Hospital Insurance)
Coverage for inpatient care in hospitals or
inpatient skilled care in a nursing facility as well as
hospice and home health care.
You are eligible for Medicare Part A if you or your spouse paid into Social Security for at least 10 years through your employment and if you are a citizen or permanent resident of the U.S.
Most individuals do not pay a premium for Part A
because they or their spouse paid Medicare taxes
while working.
Part A has deductibles, co-payments and co-insurance.
What you need to know
Deductible: This is the amount you pay first before sharing your costs with us.
Copay: Fixed amount, like $25 you pay when you receive care or pick up a prescription.
Coinsurance: This is similar to a copay but instead of a fixed dollar amount, it is a percentage of the
total bill. For example, if your child’s eyeglasses are $100 and you’ve met your deductible, your
coinsurance payments of 50% would be $50. We would pay the rest, or $50.
Out-of-pocket maximum : This is the most you could ever pay in a year on covered health care services, excluding your monthly premium. Any deductible, copay, coinsurance or out-of-pocket cost for covered services goes towards your out-of-pocket maximum. If you reach this amount, all you need to do is to continue paying your monthly premium. We will pay 100% of the cost when you get care for covered services.
Medicare Part B (Medical Insurance)
Coverage for services and supplies to treat a
medical condition and preventive services to
prevent or detect a medical illness in the early
stages.
- Doctor visits
- Outpatient hospital care
- Lab tests and other medical services
- Individuals residing in the United States
(except residents of Puerto Rico) who become
entitled to premium-free eligible for Medicare Part A and Enrolled in Medicare Part B. - Part B requires a monthly premium which
most people have deducted directly from their
monthly social security check - In addition, there is a Part B annual deductible
amount and other costs (such as copayments
and coinsurance) that may apply.
Medicare Part C (Medicare Advantage Plans)
Medicare Advantage plans are Medicare-approved
health insurance plan options oered by private
health insurance companies like Excellus
BlueCross Blue Shield, MVP, Aetna, United Healthcare, Wellcare, Humana and others.
When you enroll in a Medicare Advantage plan,
your Part A (hospital insurance) and Part B
(medical insurance) will be covered under a
single plan.
Many of our Medicare Advantage plans include
extra benefits such as prescription drugs, dental,
vision, routine physicals, hearing and/or health
and wellness programs. Please note that hospice
services are not covered under Medicare
Advantage plans, as they are paid for by Original
Medicare when you enroll in a Medicare-approved
hospice program.
Medicare Advantage Plans include:
- Health Maintenance Organizations (HMO & HMO-POS)
- Preferred Provider Organizations (PPO)
- Most of our Medicare Advantage Plans also offer prescription drug coverage.
| PPO | HMO | HMO-POS |
|---|---|---|
| Preferred Provider Organization | Health Maintenance Organization | Health Maintenance Organization-Point-of-Service |
| No Primary Care Physician | Primary Care Physician | Primary Care Physician |
| In-Network & Out-of-Network Providers | In-Network Providers | In-Network & Out-of-Network Providers |
If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the
plan and aren’t paid for under Original Medicare.
Medicare Part D (Prescription Drug Coverage)
Part D prescription drug coverage is a way to cover
the cost of your prescription drugs and is available
through private health insurance companies. Private Insurance Companies offer Medicare
prescription drug coverage through Medicare
Advantage plans that include both health care and
prescription drug coverage. Medicare Part D is
available for eligible participants.
Medicare Advantage Plans may also offer
prescription drug coverage that follows the same
rules as Medicare Prescription Drug Plans.
Veterans medicare Plans
Title 1
Title 2
Title 3
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