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Medicare Parts

There are four parts of Medicare

  • Part A provides inpatient/hospital coverage. Commonly referred to as Hospital 
  • Part B provides outpatient/medical coverage. Commonly referred to as Doctor
  • Part C offers an alternate way to receive your Medicare benefits (see below for more information).
  • Part D provides prescription drug coverage.


The four parts described are used in different combinations to provide you with the best options for your health insurance coverage. Original Medicare includes Part A and Part B, coverage will provide most medically necessary health coverage. This does not include dental, vision or hearing coverage. 

After you pay your deductibles, Original Medicare pays its share, you may pay, co-insurance as much as 20% of the costs. As a quick note, typically beneficiaries who use Original Medicare, purchase a Medicare Supplement Plan (Medigap) to cover deductibles and co-insurance. Original Medicare pays directly for the health care services you receive.

Original Medicare

Part A Hospital and Part B Doctor

Medicare Advantage

Part A + Part B + Part C

Original Medicare

Medicare Advantage

You can go to any doctor that accepts MedicareIn most cases, you’ll need to use doctors who are in the plan’s network (for non-emergency or non-urgent care). Ask your doctor if they participate in any Medicare Advantage Plans.
In most cases you don’t need a referral to see a specialist.You may need to get a referral to see a specialist.

Cost $

Original Medicare

Medicare Advantage

For Part B covered services, you usually pay 20% of the Medicare approved amount after you meet your deductible.Out-of-pocket costs vary – some plans have a low or no out-of-pocket costs.
You pay a premium (monthly payment) for Part B.. If you choose to buy a prescription drug coverage.You may pay a premium for the plan (most include prescription drug coverage) and a premium for Part B.

Some plans have a $0 premium or will help pay all or part your Part B premium.
There is no yearly limit on what you pay out-of-pocket.Plans have a yearly limit in what you pay out-of-pocket for Medicare Part A and Part B covered services. Once you reach your plans limit, you'll pay nothing for Part A and Part B covered services for the rest of the year.
You can buy Supplemental coverage to help pay your out-of-pocket costs (like your deductible and 20% co-insurance).You can’t buy or use separate supplemental coverage – but some plans have a lower out-of-pocket cost than Original Medicare.

Coverage

Original Medicare

Medicare Advantage

Original Medicare covers medical services and supplies in hospitals, doctors' offices, and other health care settings.Plans must cover all of the services that Original Medicare covers. Some plans offer extra benefits that Original Medicare doesn’t cover—like vision, hearing, or dental.
You can join a separate Medicare Prescription Drug Plan to get drug coverage.Prescription drug coverage is included in most plans.
In most cases, you don’t have to get a service or supply approved ahead of time for it to be coveredIn some cases, you have to get a service or supply approved ahead of time for it to be covered by the plan.

Travel

Original Medicare

Medicare Advantage

Original Medicare generally doesn't cover care outside the U.S. You may be able to buy supplemental coverage that covers care outside the U.S.Plans usually don't cover care outside the U.S. Also, plans usually don't cover non-emergency care you get outside of your plan’s network

You Choose Original Medicare or Medicare Advantage

Unless you choose otherwise, you will have Original Medicare. Instead of Original Medicare, you can decide to get your Medicare benefits from a Medicare Advantage Plan, also called Part C or Medicare private health plan. Remember, you still have Medicare if you enroll in a Medicare Advantage Plan. This means that you must still pay your monthly Part B premium (and your Part A premium, if you have one). Each Medicare Advantage Plan must provide all Part A and Part B services covered by Original Medicare, but they can do so with different rules, costs, and restrictions that can affect how and when you receive care.

It is important to understand your Medicare coverage choices and to pick your coverage carefully. How you choose to get your benefits and who you get them from can affect your out-of-pocket costs and where you can get your care. For instance, in Original Medicare, you are covered to go to nearly all doctors and hospitals in the country. On the other hand, Medicare Advantage Plans typically have network restrictions, meaning that you will likely be more limited in your choice of doctors and hospitals. However, Medicare Advantage Plans can also provide additional benefits that Original Medicare does not cover, such as routine vision or dental care.

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