What is Medicare?
Medicare is a government health insurance program for people age 65 or older. It may also cover certain younger people with disabilities, as well as those suffering from End-Stage Renal Disease (ESRD).
The Parts of Medicare – Parts A, B, C & D
Medicare benefits provided by the federal government, known as Original Medicare, have two parts – A & B. Enrolling in Medicare Part A and Part B is done through the federal government, not a private insurance company.
Medicare Part A
Medicare Part A (hospital insurance) helps cover:
- Inpatient care in hospitals
- Skilled nursing facility care
- Hospice care
- Home health care
Medicare Part B
Medicare Part B (medical insurance) helps cover:
- Services from doctors and other health care providers
- Outpatient care
- Home health care
- Durable medical equipment
- Many preventive services
With Original Medicare you have a choice of doctors, hospitals and other providers that accept Medicare.
The Medicare coverage provided by the federal government (parts A & B as identified above) is not intended to cover all of your healthcare needs. That is why many Medicare beneficiaries choose additional coverage offered by private insurance companies.
Medicare Part C - Medicare Advantage
Medicare Advantage (Part C) is an insurance plan offered by private insurance companies as an alternative to Original Medicare. Medicare Advantage plans include all the benefits of Medicare Parts A and B, PLUS extra benefits not available through Original Medicare. Medicare Advantage plans vary but they may include additional benefits such as:
- Prescription drug coverage
- Vision benefits
- Dental benefits
- Hearing benefits
The additional benefits provided by Medicare Advantage plans vary by insurance company so it is important for Medicare beneficiaries to look for a plan that meets their full healthcare needs.
Many times these plans will have little or no premium because the federal government pays the insurance company to administer the Part A and Part B benefits. This helps reduce the cost of providing benefits to the beneficiaries.
Most Medicare Advantage plans have a network of doctors, hospitals and other providers you need to use in order to get the lowest cost of care. If you don’t use the network providers, you may pay more or all of the costs associated with your care.
Private insurance companies must be approved by the government to offer a Medicare Advantage plan.
Medicare Part D - Prescription Drug Plans
Medicare Part D helps cover the cost of prescription drugs. Prescription drug coverage is NOT included in Original Medicare so beneficiaries who want this coverage must either choose a Medicare Advantage plan that includes prescription drug coverage or purchase a separate Part D plan. When Part D is included in a Medicare Advantage plan, the plan is referred to as a Medicare Advantage Prescription Drug plan or MAPD.
Part D plans are offered by Medicare-approved private insurance companies that must follow rules set by Medicare.
A Medicare Advantage Prescription Drug (MAPD) plan, like the one offered by Sunshine Health, combines Part A (hospital insurance) and Part B (medical insurance) coverage along with Part D (prescription drug coverage) into one complete plan to fit your needs.
Last Updated: 09302016