Medicare is the health insurance program administrated by the federal government through the Centers for Medicare & Medicaid Services (CMS), which is a division of the U.S. Department of Health and Human Services (HHS).
Medicare serves people who are 65 or older, certain younger people who are disabled, and people experiencing permanent Kidney failure (also known as End-Stage Renal Disease or ESRD).
Hart Insurance has agents certified to help navigate the often confusing and complicated landscape, so don’t hesitate to call us with any questions you have.
Below is a brief explanation of the different pieces of Medicare and what they cover.
Medicare Part A (Hospital Insurance)
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Most people have paid into Medicare throughout their working careers and do not have to pay a premium for Part A. Those who have not worked enough may have to pay a premium for part A.
Medicare Part B (Medical Insurance)
Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. These are often services like primary care and specialist office visits, lab, X-ray and Imaging services. Part B requires a premium to be enrolled. Additionally, you may have to pay a penalty for not enrolling in Part B when you become eligible if you don’t have other qualifying coverage (like an employer-plan) so be sure to understand your situation.
Part A & B together are known as Original Medicare. The Parts listed below are additional products sold by private companies that you can purchase in addition to Original Medicare.
Medicare Part C (Medicare Advantage Plans)
Medicare Advantage plans are offered by private insurance companies that contract with Medicare to provide you with all your Part A and Part B benefits. If you enroll in a Medicare Advantage plan, most if not all of your care will be covered by the plan instead of Original Medicare. Most Medicare Advantage Plans include prescription drug coverage (Part D) as well. You must remain enrolled in both Part A & B to enroll in a Medicare Advantage plan.
Medicare Part D (prescription drug coverage)
Part D adds prescription drug coverage to Original Medicare. Like Part C, Part D plans are offered by private insurance companies approved by Medicare. Similar to Part B, you may have to pay a penalty for not enrolling in Part D when you become eligible if you don’t have other qualifying coverage (e.g. VA coverage) so be sure to understand your situation.
Medicare Supplement (AKA Medigap) Plans
Supplements are not formally a “Part” of Medicare like those listed above. They are, however, also sold by private insurance companies, like Part C and Part D plans. Supplement plans were built, just as their name indicates, to supplement Original Medicare (A & B). Supplement Plans start covering you where Original Medicare leaves off. Supplements only pay if Medicare pays first, so if Medicare doesn’t cover a service, the Supplement won’t either. Supplement plans do not formally include prescription coverage (Part D), though some companies market and sell them as a “bundle” or “package”.
Possible Coverage Combinations:
· Original Medicare (A & B)
· Original Medicare (A & B) + Part D (Prescription)
· Original Medicare (A & B) + Part C (Medicare Advantage w/or w/out Prescription)
· Original Medicare (A & B) + Medicare Supplement + Part D (Prescription)
· Original Medicare (A & B) + Part C (Medicare Advantage) + Part D Prescription) [only under specific conditions]