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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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