Medicare is a health insurance program overseen by the federal government. When you turn age 65, you are entitled to Medicare as long as you are a U.S. citizen or permanent legal resident of the U.S. who has lived here at least five years.
There are four “parts” to Medicare, and it’s important that you know what each part covers. You’ll hear and read a lot about these, especially Part A, Part B, and Part D. (You’ll hear about Part C, too, but the name “Medicare Advantage” is more commonly used for Part C plans).
In addition to the summary about each part below, you can learn even more about Medicare by requesting or downloading the government’s booklet, Medicare & You, which is published and updated every calendar year. The booklet is free.
What are Medicare’s Four “Parts”?
Part A is coverage for inpatient hospital stays and/or care at a skilled nursing facility. In most cases, people do not have to pay for Part A protection.
Part B is medical coverage for services that include doctor visits, outpatient procedures, preventative screenings, check-ups and other medical services other than inpatient hospital stays and care at skilled nursing facilities. People do have to pay a monthly premium for Part B protection, and that premium is set by the federal government each year.
Part C is a special type of Medicare coverage known as “Medicare Advantage” coverage. These types of plans are offered by various insurance companies under the government’s rules and guidelines. Part C “Medicare Advantage” plans combine the Part A and Part B coverage (and sometimes Part D coverage, too). People who choose Part C plans normally are required to use a network of hospitals, doctors and other providers in order to receive the plans’ maximum coverage. Additionally, as services are received, Part C recipients normally have to pay co-payments, co-insurance and other expenses.
Part D covers prescription drugs. You are not required to enroll into a Medicare Part D Prescription Drug Plan. However, if you go without creditable prescription drug coverage for 63 or more days in a row, you may have to pay a late-enrollment penalty if you enroll into a Medicare Prescription Drug Plan (PDP) or Medicare Advantage Prescription Drug plan later (MA-PD). Part D plans are offered by various insurance companies under the government’s rules and guidelines. People with Part D must pay a monthly premium for this coverage, and the amount of the premium will vary from one company to the next.
Does Medicare cover prescription drugs?
If you use Medicare, you can join a private health plan that pays for prescription drugs. This coverage is called Part D, or the Medicare prescription drug benefit. Each insurance company that offers a Part D plan decides which drugs it will cover and what they will cost. Look carefully at the details of each plan before you choose one.
You pay a monthly fee, called a premium, to get prescription drug coverage. You still pay the monthly fees for Part B if you have it.
You can also get Part D benefits by joining one of these plans--a Medicare Advantage (Part C) plan that has a prescription benefit or a Medicare Cost Plan with prescription medicine benefits. The premium you pay for one of these plans includes medicine coverage.
Because each person’s prescription drug needs are unique, Medicare has made the process easier by offering an online Plan Finder tool at medicare.gov.
You need to decide whether to get Part D coverage as soon as you are eligible. If you wait, you may have to pay a penalty for joining late. If you cannot afford a prescription drug plan, financial help may be available. For more information or to get help, you can visit your local State Health Insurance Assistance Program (SHIP). Each SHIP has people trained to help you understand your Medicare benefits and answer questions you have about your Medicare coverage.
Find out more about Members Health Insurance Part D plans.