Understand your Medicare Advantage coverage options.
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Understanding the basics means understanding your choices.
With so many Medicare coverage options to choose from, you may wonder where you should start. The chart below will help you learn more about the A, B, C, and Ds of Medicare.
Original Medicare
Part A
- Inpatient Hospital Care
- Nursing/Hospice Care
- Exams
- Outpatient Visits
- Lab Tests/Imaging
- Surgery
- Medical Equipment
- Wellness Services
- Routine Vision
- Routine Hearing
- Prescription Drugs
- Hospital Care Deductible (Part A)
- Tests & Surgery Deductible (Part B)
Original Medicare
Part B
- Inpatient Hospital Care
- Nursing/Hospice Care
- Exams
- Outpatient Visits
- Lab Tests/Imaging
- Surgery
- Medical Equipment
- Wellness Services
- Routine Vision
- Routine Hearing
- Prescription Drugs
- Hospital Care Deductible (Part A)
- Tests & Surgery Deductible (Part B)
Medicare Advantage
Part C
- Inpatient Hospital Care
- Nursing/Hospice Care
- Exams
- Outpatient Visits
- Lab Tests/Imaging
- Surgery
- Medical Equipment
- Wellness Services
- Routine Vision
- Routine Hearing
- Prescription Drugs
- Hospital Care Deductible (Part A)
- Tests & Surgery Deductible (Part B)
Prescription Drug
Part D
- Inpatient Hospital Care
- Nursing/Hospice Care
- Exams
- Outpatient Visits
- Lab Tests/Imaging
- Surgery
- Medical Equipment
- Wellness Services
- Routine Vision
- Routine Hearing
- Prescription Drugs
- Hospital Care Deductible (Part A)
- Tests & Surgery Deductible (Part B)
Original Medicare: Parts A and B
Original Medicare is managed by the federal government and is just a starting point for your health care.
- Part A covers in-patient medical hospital care, nursing facilities, hospice, and some home health care.
- Part B helps cover doctor visits, outpatient care, and some preventive services.
Medicare Advantage: Parts C
Medicare Advantage is offered by private insurers and combines the benefits of Parts A & B plus other potential benefits.
- Maximum out-of-pocket limit per plan year means 100% of allowed healthcare costs after you meet your out-of-pocket limit
- Helps you control and understand your financial risk
Common Types of Medicare Advantage Plans
Health Maintenance Organization (HMO)
- Usually requires you to get most care and services from in-network providers
- Costs are lower with in-network providers
- Must choose a Primary Care Physician (PCP)
- Need referrals to see a specialist
Preferred Provider Organization (PPO)
- Provide you with a preferred network
- Costs are lower with in-network providers
- Costs are generally higher with out-of-network providers
- There usually isn't a need to have a referral to see a specialist
Dual Eligible Special Needs (D-SNP)
- Designed to coordinate covered benefits and services if you qualify for both Medicare and Medicaid
Medicare Advantage and Prescription Drug Coverage: Part D
If you rely on prescription drugs to maintain your health, you have several options for prescription drug coverage:
- Some Medicare Advantage (Part C) plans include prescription drug coverage (MAPD)
- If you have Original Medicare (Parts A & B), you can purchase a Prescription Drug Plan (PDP)
- Includes mail-order service to help you save money and time
- You may need to pay a deductible
Stages of Coverage
1. Deductible
The amount you pay before a plan covers your prescription drug costs, if applicable.
2. Initial Coverage
The plan pays its share of the cost, and you pay your share. This stage lasts until your payments and the plan’s payments total $5,030 for the year.
3. Coverage Gap
Begins when your drug costs and plan payments for the year reach $5,030. You will pay 25% of the cost for covered generic and brand-name drugs until your out-of-pocket costs for the year reach $8,000.
4. Catastrophic Coverage
If your out-of-pocket costs for prescription drugs reach $8,000, you will pay $0 for brand and generic drugs for the remainder of the year.
