Original Medicare: Part A & Part B

Medicare Part A (Hospital Insurance)

Medicare Part A helps cover inpatient hospital stays, skilled nursing facility care, hospice care, and limited home health services. Most people qualify for Part A at no monthly premium if they or their spouse paid Medicare taxes while working. Part A focuses mainly on hospital-related care rather than routine medical services. Deductibles and cost-sharing may apply.

Medicare Part B (Medical Insurance)

Medicare Part B helps cover doctor visits, outpatient care, preventive services, diagnostic tests, and durable medical equipment. Part B requires a monthly premium and includes an annual deductible and coinsurance. Together, Parts A and B make up Original Medicare. Original Medicare does not include prescription drug coverage or routine dental, vision, or hearing care.

Medicare Advantage (Part C & MAPD Plans)

Medicare Advantage plans are offered by private insurance companies and provide Medicare Part A and Part B coverage in one plan, often including a built-in prescription drug plan (MAPD). Many plans also offer extra benefits such as dental, vision, hearing allowances, over-the-counter (OTC) benefits, food or grocery cards, and wellness programs like SilverSneakers®. Most plans feature low or $0 monthly premiums and include an annual out-of-pocket maximum to help protect against high medical costs.

Special Needs Plans

C-SNP (Chronic Condition Special Needs Plans) are for individuals with qualifying chronic conditions such as diabetes, heart disease, or other long-term illnesses.

D-SNP (Dual Eligible Special Needs Plans) are for individuals who qualify for both Medicare and Medicaid and often include enhanced benefits and lower out-of-pocket costs.
Eligibility is required for enrollment in these plans.

Stand-Alone Prescription Drug Plans (Part D / PDP)

Stand-alone Prescription Drug Plans help cover the cost of prescription medications for those enrolled in Original Medicare or Medicare Supplement plans. These plans are offered by private insurance companies and have their own formularies, pharmacy networks, and pricing structures. Costs and coverage vary by plan. Reviewing your prescription coverage annually is important to ensure affordability and continued coverage.

Medicare Supplement (Medigap) Plans

Medicare Supplement plans work alongside Original Medicare to help cover costs such as deductibles, copayments, and coinsurance. These plans do not replace Medicare but instead help reduce out-of-pocket expenses. Medigap plans typically offer predictable costs and nationwide provider access. Prescription drug coverage is not included and must be purchased separately.