About Medicare Plans

Medicare Part A: Hospital Insurance

Part A covers:

• Up to 150 days in the hospital
• Up to 100 days in a skilled nursing facility (after a 3-day qualifying inpatient hospital stay)
• Home health care
• Hospice care

You’re responsible for:

• Copays
• Deductibles
• Coinsurance

Medicare Part B: Medical Insurance

Part B covers:

• Doctor visits (for regular screenings, vaccines, an annual wellness visit, and illnesses or injuries)
• Outpatient surgery
• Ambulance (in an emergency)

You’re responsible for:

• Copays
• Deductibles
• Coinsurance

Gaps in Original Medicare

Original Medicare covers a lot, but it doesn’t pay for all the health care you may need. If you only have Part A and Part B coverage, you’ll pay the full cost for services Original Medicare doesn’t cover, including:

• Routine dental care
• Hearing aids
• Routine eye exams and eye wear
• Routine physical exams
• Fitness club memberships
• Prescription drugs you may take at home
• Care in a skilled nursing facility without a qualifying 3-day hospital stay
• Most care you receive when traveling outside the U.S.

Medigap Plans

If you choose Original Medicare, you can buy extra coverage from private insurance companies to help pay for things that Medicare Part A and Part B don’t cover. Medigap plans, also known as Medicare Supplement plans cover things like coinsurance and copays, deductibles, your share of extended hospital stays, blood transfusions, and foreign travel emergencies. Medicare Supplement plans do not include Medicare Part D outpatient prescription drug coverage.

Medicare Part C: Medicare Advantage plans

Part C is also known as Medicare Advantage. These are private plans that cover everything Original Medicare does plus many include prescription drugs coverage and other extras.

Medicare Advantage plans cover:

• Everything Original Medicare covers
• Extras like vision, dental, and fitness benefits (depending on the plan)
• Many also include Medicare Part D outpatient prescription drug coverage

You’re responsible for:

• Monthly premiums
• Copays
• Deductibles
• Coinsurance

Medicare Part D: Outpatient prescription drug coverage

You can purchase Medicare Part D coverage from private health care companies to help cover the cost of your prescriptions. There are two ways to get Part D:

• As part of a Medicare Advantage plan (MA-PD)
• As a separate, standalone prescription drug plan (PDP)

Medicare Part D covers:

• Prescription drugs you take as long as they are on your plan’s drug list or formulary. Drug lists vary by plan, so it’s important to check that your prescriptions are included before you pick a plan.

A note on penalties

You don’t have to get a Part D plan when you enroll in Medicare. But if you don’t sign up when you first become eligible, you may pay a late enrollment penalty if you decide to sign up later. You’ll pay the penalty for as long as you have Part D coverage. To learn more about penalties related to Part D enrollment, visit the Medicare website.

Phases of Part D coverage

Part D coverage is broken into a few phases:

• Deductible
• The initial coverage phase is where you’ll pay co-insurance specified in your plan. Once your total drug costs (what you and your plan pay) reach $4,660, you move into what’s called the coverage gap.
• During the coverage gap, you receive a 75% discount on drug costs. You pay 25% of the drug costs until your total out-of-pocket costs, including what you paid out-of-pocket in the deductible and initial coverage phase, reaches $7,400.
• Once you’ve reached $7,400 in out-of-pocket costs, you enter catastrophic coverage, during which the plan will pay most of the cost of your drugs. You will be responsible for small copay or 5% coinsurance, whichever is greater.

You’re responsible for:

• Monthly premiums
• Copays
• Deductibles
• Coinsurance