Medicare Parts A, B, C and D — The Difference, In Plain Words

What Medicare is

Medicare is federal health insurance.

Medicare’s own page says it is for anyone age 65 and older.

It is also for some people under 65 with certain disabilities or conditions.

Medicare’s quick guide also names people of any age with End-Stage Renal Disease.

End-Stage Renal Disease is permanent kidney failure requiring dialysis or a kidney transplant.

The guide also names people of any age with ALS, also called Lou Gehrig’s disease.

Part A: hospital insurance

Part A is Hospital Insurance.

Part A helps cover:

• Inpatient care in hospitals. Inpatient care means care when you are admitted to a hospital.
• Skilled nursing facility care.
• Hospice care.
• Home health care.

Part B: medical insurance

Part B is Medical Insurance.

Part B helps cover:

• Services from doctors and other health care providers.
• Outpatient care. Outpatient care means care you get without being admitted to a hospital.
• Home health care.
• Durable medical equipment, like wheelchairs, walkers, hospital beds, and other equipment. Durable means built to last and to be used more than once.
• Many preventive services, like screenings, shots or vaccines, and yearly “Wellness” visits. Preventive services are care meant to help prevent illness or find it early.

Home health care appears in both Part A and Part B on Medicare’s list.

That is how Medicare lists it.

Original Medicare: Part A and Part B together

Original Medicare includes Part A and Part B.

Medicare’s page gives these facts about Original Medicare:

• You can use any doctor or hospital that takes Medicare.
• You can join a separate Medicare drug plan to get Medicare drug coverage (Part D).
• You can also buy supplemental coverage that helps pay your out-of-pocket costs.

Supplemental coverage is extra coverage.

It is not one of the 4 parts on this page.

Part C: Medicare Advantage

Part C is also known as Medicare Advantage.

Medicare’s quick guide also calls these plans “MA Plans.”

Medicare says Medicare Advantage offers an alternative to Original Medicare for your health and drug needs.

Alternative means a different way.

You get benefits through a private health plan that Medicare approved.

These plans are called “bundled” plans.

Bundled means put together in one plan.

These bundled plans include Part A, Part B, and usually Part D.

Medicare’s page adds these facts about Medicare Advantage:

• You may need to use doctors in the plan’s network.
• You may need to get approval for certain drugs or services before you get them. Medicare calls that approval prior authorization.
• These plans usually have different out-of-pocket costs than Original Medicare, including a yearly limit on out-of-pocket costs.
• Most plans offer extra benefits that Original Medicare does not cover, like vision, hearing, dental, and more.

Part D: drug coverage

Part D helps cover the cost of prescription drugs.

Prescription drugs are medicines a doctor orders for you.

Medicare’s pages name 2 ways to get drug coverage:

• You can join a separate Medicare drug plan to get Medicare drug coverage (Part D), in addition to Original Medicare.
• You can get it by joining a Medicare Advantage Plan with drug coverage.

Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare.

The difference, in one list

• Part A: Hospital Insurance. It helps cover inpatient hospital care, skilled nursing facility care, hospice care, and home health care.
• Part B: Medical Insurance. It helps cover doctors and other health care providers, outpatient care, home health care, durable medical equipment, and many preventive services.
• Part C: Medicare Advantage. It is an alternative to Original Medicare. It is a bundled plan from a private company approved by Medicare. It includes Part A, Part B, and usually Part D.
• Part D: Drug coverage. It helps cover the cost of prescription drugs. The plans are run by private insurance companies that follow rules set by Medicare.

Two main ways to get Medicare coverage

Medicare’s page says there are 2 main ways to get Medicare coverage.

• Original Medicare. This is Part A and Part B.
• Medicare Advantage (also known as Part C). This is a Medicare-approved plan from a private company that offers an alternative to Original Medicare.

Medicare’s page says this about choosing:

“When you first sign up for Medicare and during certain times of the year, you can choose which way to get your Medicare coverage.”

This page does not list sign-up dates or deadlines.

For dates and choices for one person, use the official routes below.

Medicare is not Medicaid

Medicare and Medicaid have similar names, but they are not the same program.

Medicare’s page says Medicaid is a joint federal and state program that provides health coverage for certain low-income people, families and children, pregnant women, the elderly, and people with disabilities.

Medicare’s page also says: “If you qualify, you can have both Medicare and Medicaid.”

Where to check the facts for one person

This page gives general information only.

It does not give any one person’s coverage or costs.

Medicare’s own pages name these routes:

• Medicare. Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. TTY means a text telephone service for people who are deaf or hard of hearing. Medicare’s quick guide says you can connect with a real person 24 hours a day, 7 days a week, except some federal holidays.
• Your State Health Insurance Assistance Program. The short name is SHIP. Medicare’s quick guide says to visit shiphelp.org to find your local SHIP and get health insurance counseling.
• Medicare.gov. Medicare’s quick guide says to visit Medicare.gov to get more information about the Medicare health and drug plans in your area, find participating health care providers and suppliers, and more.