Medicare Part A, also known as Hospital Insurance, helps cover inpatient care in hospitals, critical access hospitals, and skilled nursing facilities.
It also covers hospice care and some home health care, but you must meet certain conditions to receive these benefits.
Medicare Part B, also known as Medical Insurance, is an optional health insurance plan that helps cover certain medical services and supplies.
Medicare Part C, also known as Medicare Advantage, is a private health plan that offers an alternative to Original Medicare.
Part C plans bundle coverage for Parts A, B, and usually Part D, and may also include additional benefits like vision, hearing, and dental care.
Medicare Part D, also known as Medicare drug coverage, helps cover the cost of prescription drugs, including many recommended vaccines and shots.
Part D plans must cover most vaccines, except for those covered by Part B, as well as anticonvulsive treatments, immunosuppressant drugs, and anticancer drugs (unless covered by Part B).
Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private health insurance company to help pay your share of out-of-pocket costs in Original Medicare.
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Generally, Medicare is for people 65 or older. You may be able to get Medicare earlier if you have a disability, End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant), or ALS (also called Lou Gehrig's disease).
What is the difference between Medicare Advantage & Original Medicare?
Original Medicare covers Part A (inpatient hospital and skilled nursing services), Part B (doctor visits, outpatient services, and some preventative care), and usually doesn't cover medical care outside the U.S..
Medicare Advantage plans cover all of Part A and Part B, and most also cover Part D (prescription drugs). Medicare Advantage plans may also offer extra benefits that Original Medicare doesn't, such as dental, vision, hearing, fitness programs, and rides to doctor appointments.
Whether you need a prescription drug plan depends on several factors, including your budget, healthcare needs, and other coverage options: Budget Consider the cost of brand-name versus generic drugs, and your ability to pay for out-of-pocket expenses.
Healthcare needs - You might want coverage in case your needs change in the future, such as if you develop a condition that requires expensive medication. Other coverage options - If you have creditable coverage from another source, like an employer or union, you might not need Part D. Creditable coverage is when Medicare considers another source to be of equal or better value than Part D
The Initial Enrollment Period (IEP) for signing up for Medicare Part A and Part B is a seven-month period that begins three months before the month you turn 65 and ends three months after. Coverage begins the month after you sign up during your IEP. If you miss your IEP, you may have to pay a penalty.
Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) differ in several ways, including cost, network coverage, and flexibility:
Cost - HMOs are generally more budget-friendly than PPOs, with lower monthly premiums, out-of-pocket costs, and sometimes no deductible. PPOs typically have higher premiums and out-of-pocket costs, and require you to meet a deductible before your insurance pays for your healthcare bills.
Network coverage - HMOs offer a narrower network of doctors, hospitals, and specialists, and you can only see in-network providers unless it's a medical emergency. PPOs generally have larger networks, and you can see in-network or out-of-network providers, though you'll pay more for out-of-network care.
Flexibility - HMOs are less flexible than PPOs. For example, HMO policyholders usually need a referral from their primary care doctor to see an in-network specialist. PPOs offer more flexibility, and you don't need prior approval or a referral to see out-of-network providers.
Original Medicare usually doesn't cover health care or supplies outside of the United States, including its territories. However, there are some exceptions, including:
Medical emergencies: If you're in the U.S. when a medical emergency occurs and a foreign hospital is closer than the nearest U.S. hospital. This also applies if you're traveling between Alaska and another U.S. state through Canada and a Canadian hospital is closer than the nearest U.S. hospital. Medicare determines what qualifies as "without unreasonable delay" on a case-by-case basis.
Vaccines: Medicare may cover vaccines outside of the U.S..
Paul Uvanitte
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We do not offer every plan in your area. Currently, we represent 9 organizations which offer 52 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
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