Medicare 101

Medigap Plans (Supplement Plans)

Medicare Part C (Advantage Plans)

Medicare Part B (Outpatient)

Medicare Part A (Hospital)

What is Medicare?

Medicare is a national program administered by the Federal government, comprising:

  • Part A – Hospital Insurance Inpatient hospital, inpatient skilled nursing facility, hospice, and some home health services
  • Part B – Medical Insurance Physician services, outpatient care, durable medical equipment, home health services, and many preventive services
  • Part C – Medicare Advantage (MA) Medicare-approved private insurance companies that provide all Part A and Part B services and may provide prescription drug coverage and other supplemental benefits.
  • Part D – Prescription Drug Benefit Medicare-approved private insurance companies that provide outpatient prescription drug coverage.

Medicare Health care coverage is for:

  • People 65 or older
  • People younger than age 65 with certain disabilities entitled to Social Security disability or Railroad Retirement Board benefits for 24 months People with certain disabilities
  • People diagnosed with end-stage renal disease (ESRD)

Medicare is the nation’s largest payer of inpatient hospital services for the elderly and people with ESRD.

What services does Medicare cover?

Medicare Part A and Part B cover certain medical services and supplies in hospitals, doctors’ offices, and other health care settings.

Medicare Part D covers prescription drugs.

Your red, white, and blue Medicare card shows whether you have Part A (listed as HOSPITAL), Part B (listed as MEDICAL), or both, and the date your coverage begins.

If you have Original Medicare, you’ll use it to get your Medicare-covered services.

What is NOT covered by Part A and Part B?

Some of the items and services that Original Medicare doesn’t cover include:

✖ Most dental care

✖ Eye exams (for prescription glasses)

✖ Dentures.

✖ Cosmetic surgery

✖ Massage therapy

✖ Routine physical exams

✖ Hearing aids and exams for fitting them

✖ Long-term care

✖ Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care)

✖ Covered items or services you get from an opt-out doctor or other provider (except in the case of an emergency or urgent need)

Medicare Supplement Insurance (Medigap)

Can be added to Original Medicare.

How does Medigap work?

Original Medicare, (Parts A & B), pays for much, but not all, of the cost for covered health care services and supplies. Medicare Supplement Insurance (Medigap) policies sold by private companies, can help pay some of the remaining health care costs for covered services and supplies, like copayments, coinsurance, and deductibles. Some Medigap plan also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. Generally, Medigap doesn’t cover long-term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, or private-duty nursing. Medigap plans are standardized Medigap must follow federal and state laws designed to protect you, and they must be clearly identified as “Medicare Supplement Insurance.” Insurance companies can sell you only a “standardized” plan, identified in most states as plans A – D, F, G, and K – N. All plans offer the same basic benefits, but some offer additional benefits so you can choose which one meets your needs. You can go to any doctor or hospital that takes Medicare, anywhere in the U.S.

Medicare Advantage (also known as Part C)

Medicare Advantage is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.

  • Plans may have lower out-of-pocket costs than Original Medicare.
  • In many cases, you’ll need to use doctors who are in the plan’s network.
  • Most plans offer extra benefits that Original Medicare doesn’t cover—like vision, hearing, dental, and more.

In many cases, you’ll need to use doctors and other providers who are in the plan’s network and service area for the lowest costs. Some plans won’t cover services from providers outside the plan’s network and service area.