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Glenn Cromwell
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MEDICARE

Doctor showing a tablet to a patient outside a clinic.

What is Medicare?

Medicare is a federal health insurance program primarily for people age 65 and older, as well as certain younger individuals with disabilities or specific medical conditions. It helps cover many health care costs, including hospital stays, doctor visits, preventive services, and prescription medications.

Choosing the right Medicare plan can help you protect your health while managing your out-of-pocket expenses.

Parts of Medicare

Understanding Medicare is easier when you know its four parts. Each part covers different health care services.


Medicare Part A – Hospital Insurance

Part A helps cover:

  • Inpatient hospital stays 
  • Skilled nursing facility care 
  • Hospice care 
  • Some home health care 

Most people qualify for premium-free Part A if they or their spouse paid Medicare taxes while working.


Medicare Part B – Medical Insurance

Part B helps cover:

  • Doctor visits 
  • Outpatient care 
  • Preventive services and screenings 
  • Lab work and X-rays 
  • Durable medical equipment 
  • Some home health services 

Part B generally requires a monthly premium.


Medicare Part C – Medicare Advantage

Medicare Advantage plans are offered by private insurance companies approved by Medicare. These plans combine Part A and Part B coverage and often include additional benefits such as:

  • Prescription drug coverage (most plans) 
  • Dental 
  • Vision 
  • Hearing 
  • Fitness programs 
  • Transportation and other extra benefits 


Medicare Part D – Prescription Drug Coverage

Part D helps pay for:

  • Prescription medications 
  • Vaccines 
  • Certain recommended immunizations 

Part D plans are offered by private insurance companies and help reduce the cost of prescription drugs.

What is a Medicare Supplement Plan (Medigap)?

A Medicare Supplement Plan, also known as Medigap, is private health insurance that helps pay some of the out-of-pocket costs that Original Medicare (Part A and Part B) doesn't cover.

These costs may include:

  • Deductibles 
  • Coinsurance 
  • Copayments 
  • Certain excess charges (depending on the plan) 

Medigap plans work alongside Original Medicare, giving you greater financial protection and helping reduce unexpected medical expenses.


Is a Medicare Supplement Plan Right for You?

A Medicare Supplement plan may be a good option if you:

  • Want predictable out-of-pocket medical costs 
  • Prefer the freedom to see any doctor or specialist in the U.S. who accepts Medicare—without referrals 
  • Travel frequently within the United States 
  • Value comprehensive coverage and flexibility 

Important: Medicare Supplement plans do not typically include prescription drug coverage. If you choose a Medigap plan, you may also need to enroll in a separate Medicare Part D Prescription Drug Plan..

What is a Medicare Advantage Plan (Part C)?

A Medicare Advantage Plan (Part C) is an alternative to Original Medicare. These plans are offered by private insurance companies approved by Medicare and provide all the benefits of Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) in one plan.

Many Medicare Advantage plans also include additional benefits not covered by Original Medicare, such as:

  • Prescription drug coverage (Part D) on many plans 
  • Routine dental care 
  • Vision exams and eyewear 
  • Hearing exams and hearing aids 
  • Fitness and wellness programs 
  • Transportation to medical appointments 
  • Over-the-counter (OTC) allowances 
  • Other extra benefits, depending on the plan 


Is a Medicare Advantage Plan Right for You?

Choosing the right Medicare coverage is one of the most important health care decisions you'll make. A Medicare Advantage plan can be an excellent option for many people—but it's not the right fit for everyone.

A Medicare Advantage plan may be right for you if you:

  • ✔️ Want your hospital and medical coverage combined into one plan. 
  • ✔️ Would like extra benefits such as dental, vision, hearing, fitness programs, and over-the-counter allowances. 
  • ✔️ Want prescription drug coverage included in one plan (available with many Medicare Advantage plans). 
  • ✔️ Are looking for low monthly premiums, with many plans offering a $0 premium (you must still pay your Medicare Part B premium). 
  • ✔️ Are comfortable using a network of doctors, hospitals, and specialists, depending on the plan. 
  • ✔️ Want the security of an annual maximum out-of-pocket limit for covered medical expenses.

Every Medicare Advantage plan is different, so it's important to compare plans, costs, provider networks, prescription drug coverage, and benefits before enrolling.


What is a Prescription Drug Coverage?

Prescription medications are an important part of staying healthy. Understanding how drug coverage works can help you choose the Medicare plan that best fits your needs.


Original Medicare (Parts A & B)


Original Medicare covers hospital and medical services, but it does not include prescription drug coverage. If you choose Original Medicare and want help paying for your medications, you'll generally need to enroll in a stand-alone Medicare Part D Prescription Drug Plan (PDP) offered by a private insurance company.

This means you'll typically have:


  • Original Medicare (Part A & Part B) 
  • A separate Part D Prescription Drug Plan 
  • A separate monthly premium for Part D (unless your plan has a $0 premium)

 

Medicare Advantage Prescription Drug Plans (MAPD)


Many Medicare Advantage (HMO or PPO) plans combine your hospital, medical, and prescription drug coverage into one convenient plan.

Many MAPD plans offer:

  • Hospital coverage (Part A) 
  • Medical coverage (Part B) 
  • Prescription drug coverage (Part D) 
  • Additional benefits such as dental, vision, hearing, fitness programs, and more 

Some Medicare Advantage plans have a $0 monthly plan premium, meaning you pay no additional premium for the Medicare Advantage plan itself. However, you must continue to pay your Medicare Part B premium unless it is paid by another program, such as Medicaid or a Medicare Savings Program.



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