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What is Medicare?

Medicare is the federal government’s health insurance program for people 65 and older. It also covers some people younger than 65 if they have certain disabilities or kidney failure.

Medicare is comprised of four parts (A,B,C and D). Only Part A and Part B are provided by the government. Referred to as Original Medicare, these parts alone will not cover all your health care costs. To help cover these costs, you can purchase Medicare Advantage, Medicare Supplement or Part D Prescription Drug Plans.

In this article:

What is Original Medicare?Jump to
What is Medicare Advantage (Part C) Insurance?Jump to
What is Medicare Supplement Insurance?Jump to
What is Medicare Part D (Prescription Drug) Insurance?Jump to
What is the Difference Between Medicare & MedicaidJump to

What is Original Medicare?

Original Medicare is provided to you through the federal government and includes Medicare Part A and Part B. Most people enroll in Original Medicare when they turn 65. However, some people may choose to delay enrollment if they’re still working at age 65 or are covered by a spouse’s insurance.

Together, Part A and Part B cover your hospital and medical care. It does not cover all your costs though – important services related to vision, dental and hearing care as well as prescription drug coverage are not included.

Original Medicare is accepted by any provider who accepts Medicare.

Learn more about Medicare Part A (Hospital Insurance) here.

Learn more about Medicare Part B (Medical Insurance) here.

What is Medicare Advantage (Part C)?

Above we learned Original Medicare is made up of Part A and B which are provided to you by the federal government. If you decide Original Medicare isn’t right for you, you can choose to replace it with Medicare Part C.

More commonly referred to as Medicare Advantage, these plans are sold by insurance companies that are contracted with the federal government. They’re federally regulated and must provide the same coverage a Medicare Parts A and B.

Why replace Parts A and B with Part C? Medicare Advantage Plans offer extra benefits that aren’t provided by Original Medicare. These can include vision, dental and hearing care, prescription drug coverage, and even gym memberships and more. Plans also start at as little as $0 a month.

Your Medicare Advantage Plan may only be accepted by providers that are within the plan’s network.

Learn more about Medicare Advantage (Part C) here.

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What is Medicare Supplement (Medigap) Insurance?

If you would rather keep your Original Medicare coverage and instead get help paying for out-of-pocket costs, you can supplement Part A and B with a Medicare Supplement Insurance Plan.

Often referred to as Medigap, these plans work with Original Medicare to cover your Medicare copays, coinsurance, deductibles and more.

There are 10 different types of Medigap Plans named after the letters A – N. Each includes between 4 and 9 standard benefits. These plans are sold by insurance companies and come with monthly premiums.

Learn more about Medigap Insurance here.

What is Medicare Part D Prescription Drug Insurance?

Medicare Part D covers the cost of prescription drugs. Also referred to as Prescription Drug Plans, or PDP, they’re regulated by the federal government and sold by insurance companies who charge you a monthly premium for coverage.

There are two ways you can receive Part D coverage. The first is as an add-on to Original Medicare. In this case, you’d purchase a stand-alone Prescription Drug Plan. The second is through a Medicare Advantage Plan that includes Part D coverage.

Which prescriptions are covered will depend on the plan’s formulary which can vary.

Learn more about Part D here.

What’s the difference between Medicare and Medicaid?

Many people confuse Medicare and Medicaid because they sound so similar. As mentioned above, Medicare is the federal government’s health insurance program for people over 65 or with certain disabilities. There are no income requirements to be met.

Medicaid on the other hand is a state and federal health insurance program for low-income people.

You can qualify for both Medicare and Medicaid at the same time. These people are called dual-eligible. As a dual-eligible person, you may qualify for special Medicare Advantage Plans that offer additional benefits with copays starting at $0 – called Dual-Eligible Special Needs Plans.

You may also qualify for one of the several different Medicare Savings Programs that help pay for your Medicare premiums and other costs.

Learn more about the difference between Medicare and Medicaid here.

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Education is crucial in finding the right Medicare solution for you. With so many Medicare resources out there, it can be difficult finding a source you can trust. That’s why Ensurem has a Compliance Program dedicated to ensuring our Medicare content meets Centers for Medicare & Medicaid Services (CMS) regulations. So, you can rest assured you’re getting the information you need to make the right coverage decisions.

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Best-Selling Author, Creator of Fit Over 50 Magazine

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