What is Medicare?

Medicare coverage options

Medicare comes in four parts:

  • Part A — hospital insurance
  • Part B — medical insurance
  • Part C — Medicare Advantage
  • Part D — Medicare Prescription Drug Coverage

Original Medicare includes Part A and Part B. It is administered by the federal government. With Original Medicare, you can see healthcare providers throughout the U.S. who accept Medicare patients.

Part A and Part B do not include:

  • Most outpatient prescription drugs
  • Hearing aids and exams for fitting them
  • Routine vision exams and eyeglasses
  • Routine annual physical exams with lab tests
  • Dental care and dentures
  • Long-term care
  • Travel outside the U.S. with limited exceptions
  • Alternative care, including acupuncture and naturopathic services
  • Medical transport services (not by ambulance)

With a private insurer, like Moda Health, you can have more. Private insurers offer Part C and Part D.

Part C, Medicare Advantage, is the private option for Part A and Part B. It covers extra benefits that Original Medicare does not. Some of these services may include vision, hearing, dental, and other health and wellness programs.

Medicare Advantage plans limit your out-of-pocket costs for medical services. They have an annual maximum. Once you reach that, you will not pay anything for covered medical services for the rest of the year. Some Medicare Advantage plans have specific coverage areas.

For prescription drug coverage, Medicare Part D, there are two options for you:

  • You can enroll in a Medicare Advantage plan that offers prescription drug coverage
  • You can join a stand-alone prescription drug plan from a private insurer

You must already have Medicare Part A and Part B to enroll in a Part D option.

What Medicare option is right for you?

When you consider your Medicare plan options, you may want to think about the following:

  • Your lifestyle, priorities and health needs, including chronic conditions
  • Your current coverage. Is it from an employer or retiree plan?
  • Prescription drug coverage
  • Whether or not you need coverage for services that Original Medicare does not cover
  • How often you travel
  • Whether or not you live in another state for part of the year
  • Out-of-pocket costs

Should you enroll?

You can enroll in Medicare during your initial enrollment period, which is three months before your 65th birthday, your birthday month and three months after. If you are under age 65, you may be able to enroll if you have a qualifying event. Learn more about enrollment and qualifying events. And, find out what to do if you have insurance coverage from an employer.

Get the details

Last updated Oct. 1, 2022

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