Medicare Education

Medicare Education

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When you first enroll in Medicare and during certain times of the year, you can choose how you get your Medicare coverage. There are 2 main ways to get your Medicare coverage—Original Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C). Some people need to get additional coverage, like Medicare prescription drug coverage (Part D) or Medicare Supplement Insurance (Medigap).

Part A – Hospital Insurance

In general, Part A covers:

  • Inpatient care in a hospital
  • Skilled nursing facility care
  • Inpatient care in a skilled nursing facility (not custodial or long-term care)
  • Hospice care
  • Home health care

Part B – Medical Insurance

Part B covers 2 types of services:

  • Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
  • Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

Part C – Hospital and Medical Insurance + Benefits

Generally, a Medicare Advantage (Part C) plan:

  • Is offered by a private company
  • Contracts with Medicare to provide Medicare Part A (Hospital Insurance)  and Medicare Part B (Medical Insurance) benefits
  • Provides additional coverages that are not covered by traditional Medicare, such as prescription (Part D) and dental
  • Provides these benefits to people with Medicare who enroll in the plan

Part D – Prescription Drug Coverage

Each plan that offers prescription drug coverage through Medicare Part D must give at least a standard level of coverage set by Medicare. Plans can vary the list of prescription drugs they cover (called a formulary) and how they place drugs into different “tiers” on their formularies.

Your actual drug plan costs will vary depending on:

  • The drugs you use
  • The plan you choose
  • Whether you go to a pharmacy in your plan’s network
  • Whether the drugs you use are on your plan’s formulary
  • Whether you get Extra Help paying your Medicare Part D costs

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