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 and 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
- Whether the drugs you use are on your plan’s
- Whether you get paying your Medicare Part D costs
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