Similar to Social Security, Medicare is an entitlement program. Most U.S.
citizens earn the right to enroll in Medicare by working and paying their taxes
for a minimum required period. Even if you didn’t work long enough to be
entitled to Medicare benefits, you may still be eligible to enroll, but you might
have to pay more.
There are four different parts to the Medicare program. Parts A and B are
often referred to as Original Medicare. Medicare Part C, or Medicare
Advantage, is private health insurance, while Medicare Part D offers coverage
for prescription drugs. The details below tell you more about Medicare
insurance plans, with an overview of the four parts.
The “parts” of Medicare
The types of Medicare programs are often referred to as Part A, Part B, Part
C, and Part D. Here’s a rundown of what each “Part” is about.
Medicare Part A
Medicare Part A is hospital insurance. Part A covers inpatient hospital care,
limited time in a skilled nursing care facility, limited home health care services,
and hospice care.
Most Medicare Part A beneficiaries don’t have to pay a monthly premium to
receive coverage under this part of Original Medicare; this is called “premium-
free Part A.” Generally, if you’ve worked at least 10 years (40 quarters) and
paid Medicare taxes while you worked, you’re eligible for premium-free Part A.
Otherwise, you pay a monthly premium.
Medicare Part A typically doesn’t cover the full amount of your hospital bill, so
you will probably be responsible for a share in the cost. You will also have to
pay a deductible before Medicare benefits begin. Medicare will then pay 100%
of your costs for up to 60 days in a hospital or up to 20 days in a skilled
nursing facility. After that, you pay a flat amount up to the maximum number of
covered days. Your Medicare Part A benefits cover some of the costs for a
total of 90 days in a hospital and 100 days in a skilled nursing facility.
Medicare also covers up to 60 “lifetime reserve days.” These are days you
stay in a hospital longer than 90 days in a row. You get a lifetime total of 60
reserve days.
Medicare Part B
Medicare Part B is medical insurance. Part B benefits cover certain non-
hospital medical expenses like doctors’ office visits, blood tests, X-rays,
diabetic screenings and supplies, and outpatient hospital care. You pay a
monthly premium for this part of Original Medicare. The fee can be higher for
people with high incomes. A different government program, Medicaid, can
help cover Medicare Part B premiums for low-income beneficiaries.
Medicare Part B beneficiaries are usually responsible for a portion of their
health care costs. You’ll have to pay a deductible each year before your
Medicare Part B benefits kick in, and then you’ll generally pay 20% of the bill
when you go to a participating Medicare doctor. Medicare pays the full cost of
many lab tests and services requested by your doctor.
Medicare Part C
Medicare Part C or Medicare Advantage, insurance often includes every type
of Medicare coverage in one health plan. It’s offered by private insurance
companies contracted through CMS to provide a Medicare benefits package
as an alternative to Original Medicare. Enrolling into a Medicare Advantage
plan is optional, but to obtain this private insurance, you must also have
Original Medicare, Part A and Part B. You also may have to continue to pay
your Part B premium if you have a Medicare Advantage plan.
While Medicare Advantage plans are required to provide all Medicare Part A
and Medicare Part B benefits (except hospice care), plans can also include
different additional benefits, which vary among the individual private health
insurers. Many Medicare Advantage plans include prescription drug coverage,
known as Medicare Advantage Prescription Drug plans. Some plans might
have a lower deductible, while also allowing you to pay a smaller share of the
remaining costs. Medicare Advantage plans may even cover certain health
care services that Original Medicare, Part A and Part B, does not cover, like
eye exams, hearing aids, dental care, or health care received while traveling
outside the United States.
Medicare Part D
Medicare Part D is optional prescription drug coverage. Medicare Part D is
available as a stand-alone prescription drug plan through private insurance
companies, and the monthly fee varies among insurers. You will share in the
costs of your prescription drugs according to the specific plan in which you’re
enrolled. Those costs can include a deductible, a flat copayment amount, or a
percentage of the full drug cost (called “coinsurance”).
If you want prescription drug coverage, you can get it through a Medicare
Advantage Prescription Drug plan if there’s one in your area that offers this
coverage. You can use the simple form on this page and enter your zip code
to view a list of Medicare Advantage Prescription Drug plans in your area.
If you have limited income and cannot afford your medications even though
you receive Medicare Part D benefits, you may qualify for the Extra
Help program, which offers financial assistance for your monthly premium,
deductible, copayment, or coinsurance.
As independent agents we can offer coverage from multiple carriers in each
state. We also include Medicare Advantage and Medicare Supplement plans
for those interested in additional coverages. Our team is committed to making
sure that this process is as easy as possibly by providing you with various
plan options, full analysis and pricing.
For additional information, call us at (732) 359-3990 or submit a contact request!
