The Parts of Medicare

Parts A, B, C & D and Medicare Supplement

Before you shop, learn more about Medicare

Overview

Medicare is health insurance for people 65 and older. It also can cover some people under 65 with certain disabilities. And it covers people of any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

Your Medicare coverage choices may include:

Original Medicare (Parts A and B)
Medicare Advantage (Part C)
Medicare Prescription Drug Plan (Part D)

A Medicare Supplement Insurance Plan can be added to cover eligible health care costs that Medicare Parts A and B don’t cover.

Part A - Hospital coverage (Original Medicare)

Part A typically covers:

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

Part B - Medical coverage (Original Medicare)

Part B typically covers:

Medically necessary doctors' services
Outpatient care
Home health services
Durable medical equipment and other medical services
Many preventive services

Part C - Medicare Advantage

Medicare Advantage plans are an option for your Medicare coverage. They include Medicare Part A, Part B and may include Part D prescription drug coverage.

In general, Medicare Advantage:

Includes all Part A and Part B benefits and services
Usually includes Medicare Prescription Drug Coverage (Part D) as part of the plan
Is run by Medicare-approved private insurance companies, like Aetna
May include extra benefits and services not covered by Original Medicare

Plan options

The most common types of Medicare Plans are:

Health Maintenance Organization (HMO) Plans – Provide coverage through a network of doctors and hospitals. Typically, you must use network providers unless it’s an emergency. If you don’t, your care may not be covered.
Preferred Provider Organization (PPO) Plans – Provide coverage through a network of doctors and hospitals. In a PPO plan, you can see a doctor in or out of network. Typically, it costs more to get care out-of-network.
HMO Point-of-Service (HMO POS) Plans – Provides coverage through a network of doctors and hospitals. You may be able to see a doctor out of the network for some services. The POS option provides more choice and flexibility. But some services aren't available outside the network of contracted providers.
Special Needs Plans (SNP) – A special type of Medicare Advantage Plan that provides more focused health care for specific groups of people, such as those who have both Medicare and Medicaid.

There may be other types of Medicare Plans available.

Part D - Prescription Drug Plan

Part D coverage is available on its own or as part of many Medicare Advantage plans. These plans can also be added to:

Original Medicare (Parts A and/or B)
Medicare Supplement Plans (Medigap)
Some Private Fee-for-Service Plans (PFFS)
Medicare Medical Savings Account Plans (MSA)
Some Medicare Cost Plans

Drug Coverage Phases

Medicare has four drug coverage phases:

Deductible – This is the first phase of a Part D plan. Your deductible is the amount you must pay before Medicare or the plan begins to pay. This amount can change each year. If your plan doesn't have a deductible, then the initial coverage phase starts at once.
Initial Coverage – You pay a copay (set dollar amount) or coinsurance (percentage of the cost). Your plan covers the rest. This amount can change each year.

Coverage Gap – After you and the plan have spent enough to reach the initial coverage limit, you enter the coverage gap or “donut hole.” You may be responsible for paying a larger portion of your drug costs, depending upon the plan.

Medicare plans that include prescription drug coverage often offer different levels of coverage during the gap. Once you spend enough to get out of the coverage gap, you automatically get catastrophic coverage.

Catastrophic Coverage – You pay a smaller copay or coinsurance than you did during the initial coverage phase or the coverage gap. This lasts until the end of the plan year.

Medicare Supplement (Medigap)

Medicare Supplement insurance plans help you pay for some of the health care costs not covered by Original Medicare (Parts A and B). This includes deductibles and coinsurance. This lets you see doctors and hospitals who accept Medicare. There are no network restrictions.

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Call a plan specialist
dedicated to 1199SEIU retirees
at 1-866-429-3585 (TTY: 711)
Monday to Friday, 8 a.m. to
6 p.m., all time zones.
Or call Member Services at
the number on your ID card.

Disclaimers

Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.

This information is not a complete description of benefits. Call 1-866-539-6750 (TTY: 711).

Out-of-network/non-contracted providers are under no obligation to treat Aetna members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

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Parts A, B, C & D and Medicare Supplement

Before you shop, learn more about Medicare

Overview

Part A - Hospital coverage (Original Medicare)

Part B - Medical coverage (Original Medicare)

Part C - Medicare Advantage

Plan options

Part D - Prescription Drug Plan

Drug Coverage Phases

Medicare Supplement (Medigap)

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