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Medicare Overview

What is Medicare?

Medicare is a Federal Health Insurance Program. There are several supplements of Medicare coverage:

Part A covers inpatient hospital services, skilled nursing, hospice and home health care.
Part B covers outpatient medical services, home health care, durable medical equipment and preventive services.
Part C (Medicare Advantage) is offered by private companies and covers services under A, B, and D
Part D provides prescription drug coverage
Medicare Supplement (Medigap): Extra insurance offered by private companies that can help pay your share of costs in Original Medicare.

What is Original Medicare?

"Original Medicare" includes Medicare Part A and Part B. There are only TWO parts to Original Medicare.

*There's no yearly limit on what you pay out of pocket, unless you have supplemental coverage-like Medicare Supplement Insurance (Medigap), Medicaid, employer, retiree, or union coverage.

*page 11 of the 2025 CMS Medicare and You Handbook

Medicare Part A

Generally, Medicare Part A covers:

Inpatient care in a hospital
Skilled nursing facility care
Nursing home care (does not include custodial or long-term care)
Hospice care
Home health care

Medicare Part B

Medicare Part B covers medically necessary outpatient services and preventive care.

Generally, Medicare Part B covers:

Outpatient medical services
Preventive services
Ambulance services
Durable Medical Equipment (DME)
Mental healthcare including inpatient, outpatient and partial hospitalization
Limited outpatient prescription drugs
Clinical research

Medicare Part D

Medicare Part D covers prescription drugs.

Each Part D plan has its own "formulary" or list of drugs that they cover. These formularies place drugs into different levels or "tiers". Drugs in each tier have different costs. In general, a drug in a lower tier will cost less.

Original Medicare does not include prescription drug coverage. Enrollment in a Part D with your Original Medicare will provide prescription drug coverage.
Medicare Supplement (also called Medigap) plans do not include prescription drug benefits. Enrollment in a Part D plan with your Medicare Supplement will provide prescription drug coverage.
Many Medicare Advantage Plans already include Part D prescription drug coverage.

Medicare Part C & Medicare Supplement (Medigap)

Many beneficiaries choose to enroll in a Medicare Advantage (Part C) or Medicare Supplement (also called Medigap) plan to replace their benefits provided under Original Medicare. These plans can offer lower costs, more flexibility and additional benefits not provided under Original Medicare.

What is the difference between Medicare & Medicaid?

Medicare is a federal health insurance program that is available for eligible individuals age 65 and older (or those under 65 with certain disabilities or conditions).

Medicaid is coordinated at the State level and provides health insurance coverage and other benefits for those with limited income or resources.

When can I make changes to my plan?

You can make changes to a plan during your Initial Enrollment Period (IEP).

This is when you first become eligible to enroll in Medicare, which for most people is around the time of their 65th birthday.

You can make changes to a plan during Annual Enrollment Period (AEP).

Every year, during the Annual Enrollment Period you can switch, disenroll, or join a Medicare Advantage or Prescription Drug Plan of your choice. During AEP, you can also enroll in Original Medicare (Part A and Part B). Your new coverage will begin January 1 of the following year.

You can make changes to a plan during Open Enrollment Period (OEP).

If you are enrolled in a Medicare Advantage Plan, you can make a one-time change during the Open Enrollment Period.

You can make changes to a plan during a Special Enrollment Period (SEP).

Certain events allow you to make a change to your coverage during the year. For example, if you move outside your Plan's service area or lose your employer coverage, you may be eligible for a Special Enrollment Period.

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