Medicare 101

The parts of Medicare

• Part A (Hospital Insurance): Covers inpatient hospital, skilled nursing facility, hospice, and some home health care. There is typically no monthly premium if you or your spouse paid Medicare taxes for at least 10 years.

• Part B (Medical Insurance): Covers doctors' services, outpatient care, medical equipment, and preventive services. Most individuals pay a standard monthly premium.

• Part C (Medicare Advantage): Offered by private insurers as an alternative to Original Medicare, these plans cover all Part A and B services and often include prescription drugs (Part D) and extra benefits like vision, hearing, and dental care.

• Part D (Prescription Drug Coverage): A voluntary program through private companies to help pay for prescription drugs. It can be added to Original Medicare or a Medicare Advantage Plan. 

Original Medicare vs. Medicare Advantage

Choosing between Original Medicare (Parts A & B) and Medicare Advantage (Part C) is a key decision when enrolling. Original Medicare is managed by the federal government and allows you to see any provider accepting Medicare. It does not cover routine dental, vision, or hearing, nor does it have an out-of-pocket maximum. Prescription drug coverage requires a separate Part D plan. 

Medicare Advantage plans are administered by private insurers and may have network restrictions. They often include extra benefits and prescription drug coverage, and they have an annual out-of-pocket maximum. 

Medigap (Supplemental) insurance

If you have Original Medicare, you can buy a Medigap policy from a private company to help cover out-of-pocket costs like copayments and deductibles. You cannot have both Medigap and a Medicare Advantage Plan. 

Eligibility and enrollment

• Eligibility: Generally for U.S. citizens or legal residents age 65 or older, or younger individuals with specific disabilities, ESRD, or ALS.

• Enrollment periods: The Initial Enrollment Period is seven months around your 65th birthday. The Open Enrollment Period, from October 15 to December 7 annually, allows plan changes. 

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We do not offer every plan available in your area.  We represent a number of MA organizations, which offer products in your area.  Any information we provide is limited to those plans we do offer in your area.  Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.