There are four “corners” to your Medicare benefits, and they are Part A, Part B, Part C and Part D.
- Medicare “Part A” and “Part B” are often called “Original Medicare.”
- Medicare Advantage plans are often called Medicare “Part C” or “MA Plans.”
- Medicare Prescription Drug Coverage is often called “Part D.”
Medicare Part A (also called Original Medicare) is hospital coverage
Part A is managed by Medicare and provides Medicare benefits and coverage for:
- Inpatient hospital care
- Inpatient stays in most skilled nursing facilities
- Hospice and home health services
You usually don’t pay a monthly premium for Medicare Part A coverage if you or your spouse paid Medicare taxes while working. This is sometimes called “premium-free Part A.”
You can get premium-free Part A at 65 if:
- You already get retirement benefits from Social Security or the Railroad Retirement Board.
- You’re eligible to get Social Security or Railroad benefits but haven’t filed for them yet.
- You or your spouse had Medicare-covered government employment.
If you’re under 65, you can get premium-free Part A if:
- You got Social Security or Railroad Retirement Board disability benefits for 24 months.
- You have End-Stage Renal Disease (ESRD) and meet certain requirements.
Medicare Part B (also called Original Medicare) is medical coverage
Part B is also managed by Medicare and provides Medicare benefits and coverage for:
- Doctor and clinical lab services
- Outpatient and preventive care
- Screenings, surgical fees and supplies
- Physical and occupational therapy
Combined, Medicare Part A and Part B are sometimes also called “Original Medicare.”
Medicare Part C (also called Medicare Advantage) combines both Part A and Part B
Medicare Part C is a different way of getting Medicare Part A and Part B coverage. Medicare Advantage Plans (called MA Plans) combine Part A (hospital insurance) and Part B (medical insurance) together in one plan. They can also be combined with Part D prescription drug coverage called Medicare Advantage Prescription Drug (MA-PD) Plans. Generally, these plans are offered as:
- Medicare Advantage Preferred Provider Organizations (PPO plans)
- Medicare Advantage Health Maintenance Organizations (HMO plans)
- Medicare Advantage Private Fee-for-Service (PFFS plans)
Medicare Advantage plans are Medicare health plans offered by private companies that contract with Medicare to provide you with all your Part A and Part B benefits. MA plans provide the coverage for these benefits instead of the benefits being offered under Original Medicare. MA plans have specific rules regarding eligibility and enrollment as well as certain rules for how you get services, such as requiring you to select a Primary Care Physician or going to a contracted provider in the network for many services.
Medicare Advantage plans are available for a specific service area, meaning the location of hospitals, physicians and/or pharmacies that provide services to eligible members. Eligible members must reside in the Plan?s service area to be a member of the Plan. Not all Medicare Advantage plans are available in all counties within a state or even in multiple states.
Many MA plans include prescription drug coverage, commonly called Part D
Medicare Part D is Prescription Drug Coverage
A Medicare Part D Prescription Drug Plan (PDP) can be a stand-alone plan (not joined with other insurance), or it may be combined with a Medicare Advantage Plan called a Medicare Advantage Prescription Drug (MA-PD) Plan.