The parts of Medicare
Medicare is the federal health insurance program for people 65 and older, and for some younger people with disabilities. It is organized into parts, each covering something different.
- Part A (hospital insurance) helps cover inpatient hospital stays, skilled nursing facility care after a hospital stay, hospice and some home health care.
- Part B (medical insurance) helps cover doctor visits, outpatient care, preventive services and some medical equipment.
- Part C (Medicare Advantage) is an alternative way to receive your Part A and Part B benefits through a private insurance company approved by Medicare.
- Part D (prescription drug coverage) helps pay for the medications you take.
Parts A and B together are called Original Medicare.
Ways to get coverage
Most people choose between two main paths, then add what they need.
| Option | Who provides it | What it generally helps with | Good to know |
|---|---|---|---|
| Original Medicare (A & B) | The federal government | Hospital and medical care | Use providers that accept Medicare nationwide. No yearly out-of-pocket limit. No drug coverage on its own. |
| Medicare Advantage (C) | Private insurers approved by Medicare | Everything Parts A and B cover, often with drug coverage and sometimes extras | Plans use networks. There is a yearly limit on out-of-pocket costs for covered services. Costs and extras vary by plan. |
| Part D | Private insurers | Prescription drugs | Each plan has a drug list and pharmacy network. A late-enrollment penalty may apply if you join late. |
| Medicare Supplement (Medigap) | Private insurers | Some costs Original Medicare leaves behind, like deductibles and coinsurance | Works with Original Medicare only. Does not include drug coverage. |
Key enrollment dates
- Initial Enrollment Period: a 7-month window that starts 3 months before the month you turn 65, includes your birthday month, and ends 3 months after.
- Annual Enrollment Period: October 15 to December 7 each year. You can review and change Medicare Advantage and Part D coverage. Changes take effect January 1.
- Medicare Advantage Open Enrollment: January 1 to March 31 for people already in a Medicare Advantage plan. You can switch to another Advantage plan or return to Original Medicare (and join a drug plan).
- General Enrollment Period: January 1 to March 31 for people who missed their Initial Enrollment Period for Parts A and B. Late penalties may apply.
- Special Enrollment Periods: certain life events, such as moving outside your plan’s service area or losing other coverage, can open a window outside the usual dates.
Dates and rules can change. Confirm the latest details at Medicare.gov or by calling 1-800-MEDICARE.
Costs to understand
- Premiums: the monthly amount you pay for coverage. Most people pay a Part B premium, and some people with higher incomes pay more. Advantage, Part D and Medigap plans may charge their own premiums.
- Deductibles: what you pay before coverage starts to share costs.
- Copayments and coinsurance: your share of each service or prescription after the deductible.
- Out-of-pocket maximum: a yearly cap on what you pay for covered services. Medicare Advantage plans have one; Original Medicare does not.
Questions to ask any plan
- Are my doctors, specialists and hospital in the plan’s network?
- Are my medications on the plan’s drug list, and what will they cost me?
- Is my pharmacy in the network, and is there a lower-cost option?
- What is the total I could pay in a year, including premiums, deductibles and the out-of-pocket maximum?
- What happens if I travel or spend part of the year somewhere else?
- Do I need referrals to see specialists?
- What extras are included, such as dental, vision or hearing, and what are the limits?
Medicare.gov publishes quality Star Ratings for plans, which can help you compare.
Official resources
- Medicare.gov and 1-800-MEDICARE (1-800-633-4227)
- Your local State Health Insurance Assistance Program (SHIP) offers free, unbiased counseling
- Social Security, for enrolling in Medicare: 1-800-772-1213
Want to talk it through? Request a free callback and a licensed insurance agent will explain the options available where you live. Request a callback or call (754) 288-3939.