Getting Back to the Basics (Parts A, B, C, D)
The four parts of Medicare have many details to remember, here’s a refresher
Reviewed by: Malinda Cannon, Licensed Insurance Agent. Written by: Aaron Garcia.
Key Takeaways
Enrollees can choose between Original MedicareOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). and Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). when they first enroll and each year during the Annual Enrollment Period.
Original Medicare consists of Part AMedicare Part A, also called "hospital insurance," covers the care you receive while admitted to the hospital, skilled nursing facility or other inpatient services. Medicare Part A is part of Original Medicare. and Part BMedicare Part B is the portion of Medicare that covers your medical expenses. Sometimes called "medical insurance," Part B helps pay for the Medicare-approved services you receive..
Many Original Medicare beneficiaries also enroll in Part DMedicare Part D is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies. and MedigapMedicare Supplement Insurance (Medigap) is designed to provide coverage that Original Medicare (Parts A and B) does not. Medigap policies are purchased in addition to Original Medicare and have their own monthly premiums you'll need to pay. to increase their coverage and help with costs.
Medicare Advantage is an alternative to Original Medicare that offers at least the same amount of coverage. Enrollees usually get Part D included, as well as vision and hearing coverage.
On This Page
Of the nearly four million people that enroll in Medicare for the first time each year, roughly 70% select Original Medicare. [1] Considering about 67% [2] of all Medicare enrollees are in Original Medicare, it’s safe to assume many never look at all the options they have.
But did you know you can change your coverage every year during the Annual Enrollment Period (Oct. 15 to Dec. 7)?
In many cases, it pays to not settle for what you have. On this page, we’ll give you a rundown on the main parts of Medicare insurance and how they feed into your two main enrollment options: Original Medicare and Medicare Advantage.
Do you have the parts you need to get the most out of your Medicare benefits? Here’s an overview to find out:
Your Choice Each Year: Original Medicare or Medicare Advantage?
Regardless of your current plan, you can update and change your Medicare plan each year to suit your current needs. This kind of annual decision starts with understanding that there are two main Medicare paths you can go down: Original Medicare and Medicare Advantage.
What’s the difference between Original Medicare and Medicare Advantage? Here’s an overview:
What is Original Medicare?
Medicare is government-funded health insurance that you enroll in through the Social Security Administration. Original Medicare includes:
Medicare Part A & Medicare Part B
- Standardized, income-based costs
- Can visit any doctor that accepts Medicare
To get adequate coverage, many Original Medicare customers also enroll in:
Medicare Part D
- Prescription drug coverage
Medicare Supplement Insurance (Medigap):
- Help control Original Medicare’s high out-of-pocket costs
What is Medicare Advantage?
Medicare Advantage plans are offered by private insurance companies and provide coverage that Medicare Parts A and B don’t.
Medicare Advantage (Part C)
- Provides at least the same coverage as Original Medicare
- Often will provide coverage through Part D
- Lower out-of-pocket costs
- Coverage is limited to provider networks
To get a better feel for your options, here’s a quick breakdown of the different parts of Medicare.
What is Medicare Part A?
Medicare Part A
Part A is combined with Part B to create Original Medicare.
Part A provides coverage for inpatient stays at hospitals and other facilities such as skilled nursing facilities. It also includes home health visits and in-home hospice care.
Costs: How much you’ll pay is based on how long you or your spouse worked and paid taxes. If either of you worked 10 or more years, you probably don’t have a Part A monthly premium.
What is Medicare Part B?
Medicare Part B
Part B provides the medical portion of Original Medicare. This helps cover a long list of services that includes doctor visits, outpatient surgery, preventative health and home health.
Costs: Part B comes with a monthly premium that’s income based. Part B enrollees also pay copayments, coinsurance and a deductible. There is no out-of-pocket maximum.
What is Medicare Prescription Drug Plan (Part D)?
Prescription Drug Plan (Part D)
If you’re in Original Medicare and need any medications to maintain your health, you can add Part D to help cover your prescription drugs. Many Medicare Advantage plans include Part D coverage.
Costs: Prices vary depending on your income and where you live. If you have Original Medicare, you’ll pay your Part D premium and adjusted amount separately.
What is Medicare Supplement Insurance (Medigap)?
Medicare Supplement Insurance (Medigap)
You must be enrolled in Parts A and B to purchase Medigap. Medigap refers to a group of policies you can choose from to fill in the gaps in your Original Medicare coverage. This generally means helping with out-of-pocket costs like your copayments, coinsurance and deductible.
Costs: Medigap plan pricing varies by the plan and where you live. Each Medicare Supplement plan has its own premium and must be paid separately from your Original Medicare premiums.
What is Medicare Advantage (Part C)?
Medicare Advantage (Part C)
If you’re enrolled in Parts A and B, you can choose to receive your Medicare from private insurance companies through Medicare Advantage. You’ll get at least the same benefits as with Parts A and B, but also the lower costs and extra coverages that Original Medicare enrollees get by adding Part D and Medigap plans.
Costs: Medicare Advantage plans vary by area and carrier.
As a Medicare Beneficiary, understanding how to get the most out of your plan is key to maintaining great health as you age. So is knowing what else is available. Check out our Medicare Beneficiary Guide to learn more about the ins and outs of your Medicare coverage, including costs, enrollment periods and much more.
If you still need help figuring out the different parts of Medicare and how they work together, give GoHealth a call. One of our licensed insurance agents will look at your needs and compare it to your current plan. Then we’ll shop and show you your options. After all, enrolling at 65 is just the start of your Medicare journey.
FAQs
I’m enrolled in Original Medicare. When can I switch to Medicare Advantage?
You’ll want to make your switch during the Annual Enrollment Period, held each year between Oct. 15 and Dec. 7. If you enroll in a plan during this time, it’ll become active Jan. 1 the following year.
I enrolled in Medicare Advantage. Can I go back to Original Medicare? If so, when?
You can switch back to Original Medicare during AEP. If you enrolled in Medicare Advantage and want to go back to Original Medicare within the first three months, you can make the switch during the Medicare Advantage Open Enrollment Period, held each year from Jan. 1 to Mar. 31. The change will go into effect July 1. [3]
How do I know if I have prescription coverage?
To check, contact Medicare or log into your myMedicare online account. Your Medicare ID card won’t show your prescription coverage, but the company that provides your Part D coverage probably sent you a card for your records. You can also contact your local pharmacy to see if they have a Part D plan on file for you.