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Original Medicare Part A - hospital insurance

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Medicare Part A (35 seconds)

Generally, Medicare Part A covers your inpatient hospital stay for the first 60 days in a benefit period, except for your deductible. After 60 days you have to pay your cost-share. Inpatient care includes hospitals, critical access hospitals, inpatient rehabilitation facilities and inpatient care in a religious non-medical health care institution (coverage is related to non-medical, non-religious parts of care, like room and board).

Part A also includes:

• Inpatient stays in a skilled nursing facility (not custodial or long-term care)
• Hospice care services
• Home health care services

You usually don't pay a monthly premium if you or your spouse paid Medicare taxes while working. If you aren't eligible for premium-free Part A, you may be able to buy it. You'd need to have Part B and pay monthly premiums for both Part A and Part B.

You should sign up for Medicare Part A when you're first eligible. If you don't, your monthly premium may be 10% higher for a period of time. But you won't pay a penalty if you're able to sign up during a Special Election Period (SEP).

Medicare Part A + Medicare Part B = Original Medicare

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Original Medicare Part B - optional medical insurance

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Medicare Part B (40 seconds)

Generally, Medicare Part B covers 80% of covered costs and you pay 20% after meeting your deductible. This coverage includes:

• Doctors' services, outpatient care, home health services, durable medical equipment, and other medical services that Medicare Part A doesn't cover.
• Services that are medically necessary for diagnosis or treatment of a condition
• Some preventive services to detect health problems early, such as physical exams, shots and screenings
• Some physical and occupational therapy to prevent or lessen complications from an existing medical problem

You need to pay the Part B premium each month. The amount you pay can change each year depending on your income. Your Part B premium may come out of your Social Security benefits, or you may get a monthly bill.

You should sign up for Medicare Part B coverage when you're first eligible. If you don't, your monthly premium may cost you more each year. But if you have a group health plan from an employer, you may get a Special Election Period. Then you may not have to pay more when you're ready to enroll.

Medicare Part A + Medicare Part B = Original Medicare

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Medicare Part C - Medicare Advantage

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Medicare Part C (37 seconds)

Generally, Medicare Advantage (MA) plans:

• Offer the same or greater benefits than Original Medicare
• Include extras like wellness, vision, hearing and dental care, plus fitness club membership
• May include prescription drug coverage if you enroll in a Medicare Advantage plan with Medicare prescription drug coverage ("MAPD" plan)
• May include copays, deductibles, and/or coinsurance for covered services
• Have an annual out-of-pocket cost maximum which limits your how much you pay each year for medical services
• May require you to see doctors in their network

Costs and extra benefits may vary by plan.

You can choose from several Medicare Advantage plan options:

• Health Maintenance Organizations (HMOs) use a network of doctors and hospitals to lower your costs.
• Preferred-Provider Organizations (PPOs) offer all the benefits of an (HMO) and also let you choose doctors and hospitals outside of a network.
• Private Fee-for-Service Plans (PFFS) require no special networks or providers. You can visit any doctor or hospital that is eligible to receive payment from Medicare, agrees to treat you, and accepts the plan's terms and conditions.
• Special Needs Plans (SNPs) are designed to meet the specific needs of Medicare beneficiaries who meet one of the following criteria:
  • Are eligible for state Medicaid health insurance
  • Have needed or are expected to need the services provided by a long term care or skilled nursing facility for 90 days or longer
  • Have a specific severe or disabling chronic condition

You must have Medicare Parts A and B (Original Medicare) before you can enroll in a Medicare Advantage plan.

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Medicare Part D - prescription drug coverage

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Medicare Part D (34 seconds)

Everyone with Medicare Parts A and/or B can get drug coverage. Each plan can vary by cost and the drugs covered.

You have two choices for drug coverage under Medicare Part D:

• Prescription drug coverage as part of a Medicare Advantage plan. These plans are often called "MAPD" plans. They give you Part A, Part B, and Part D coverage in one plan, for one monthly plan premium. That premium is in addition to your Part B premium and Part A premium, if you have one. You may even pay less than you would for each separately.
• A stand-alone Medicare prescription drug plan. These plans are sometimes called "PDP" plans. They only offer prescription drug coverage. You can buy a PDP plan in addition to your existing Original Medicare (Part A and/or Part B) coverage, Medicare Supplement (Medigap) plan, Private Fee-for-Service (PFFS) plan without prescription drug coverage, some Medicare Cost Plans, or Medicare Medical Savings Account (MSA) Plans.

You should think about enrolling in a plan even if you don't take prescription drugs now. It may help you avoid future late enrollment penalties from the government. It also means you'll have prescription drug coverage if you unexpectedly need it.