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The Basics of Medicare

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Medicare is divided into several different programs, or parts.

You can opt to enroll in either Original Medicare, which includes Parts A and B, or Medicare Part C (also known as Medicare Advantage).

Medicare Part A

Medicare Part A is typically known as hospitalization insurance and covers expenses such as:

  • Inpatient care in a hospital
  • Skilled nursing home care Inpatient care in a skilled nursing facility that is not custodial or long-term
  • Hospice care
  • Home health care

Medicare Part B

Medicare Part B caters to your non-hospitalization healthcare requirements. With Part B, you are covered for:

  • Medically necessary services such as doctor visits, tests, and other services as needed to diagnose or treat your condition
  • Preventive services like routine screenings, check-ups, vaccinations, and more
  • Clinical research
  • Ambulance services
  • Durable medical equipment
  • Mental health services
  • Limited outpatient prescription drugs
Together, Medicare Parts A and B are called Original Medicare.

Medicare Part C

Medicare Part C, known as Medicare Advantage, combines the coverage of Parts A and B into a single plan provided by a private health insurance company that contracts with Medicare. According to regulations, Advantage plans must provide coverage equal to that of Original Medicare. However, some rules may vary, and additional benefits may be available within the network. Moreover, many Advantage plans incorporate Part D, which covers prescription drugs.

Common types of Part C plans include:
  • Health Maintenance Organization (HMO) plans
  • Preferred Provider Organization (PPO) plans
  • Private Fee-for-Service (PFFS) plans
  • Special Needs Plans (SNPs)
  • HMO Point of Service Plans (HMOPOS)
  • Medicare Medical Savings Account (MMSA)

Choosing a Part C plan gives you the chance to review different plans, benefits, and premiums annually during an Annual Election Period.

For additional information, please visit Medicare.gov.

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