What Are The Four Types Of Medicare?

25 minute read| Updated for October, 2020
Key Takeaways:
  • There are four parts of Medicare: Part A, Part B, Part C and Part D.
  • Medicare Part A is hospital insurance, and Part B is medical insurance. Together, Parts A and B are referred to as Original Medicare.
  • Medicare Part C, or Medicare Advantage, is an alternative to Original Medicare that is offered through private insurance companies. It usually includes extra coverage, which can cover things like prescription drugs, vision care, hearing and dental services.
  • Medicare Part D is a standalone prescription drug plan. It can be added to Original Medicare to offer drug coverage.

When you are nearing age 65, it is time to start thinking about your options for a Medicare health plan. But before you enroll in Medicare, there are several important things to consider regarding coverage.

medicare information

The Four Types of Medicare

While this process may seem overwhelming at first, the most important first question to ask is: What are the four types of Medicare? Here is a quick breakdown of Medicare the various coverage options available:

Most Medicare beneficiaries enroll in Original Medicare, which is provided by the federal government. Original Medicare pays for about 80% of approved hospital, clinic, and medical procedure costs. Often, people choose to enhance their coverage beyond this with other options.

When you enroll in Medicare, you automatically receive Medicare Part A. There typically is not a monthly premium for this coverage

What Does Medicare Part A Cover?

Original Medicare coverage is regulated according to federal and state laws. As such, when you enroll in Medicare, you automatically receive Medicare Part A. There typically is not a monthly premium for this coverage, but you likely will have a deductible.

Part A covers a range of inpatient services, such as:

  • Hospital stays
  • Skilled nursing facilities
  • Nursing home care (not custodial or long-term care)
  • Hospice care
  • Home health care services

What Does Medicare Part B Cover?

The second component of Original Medicare is Medicare Part B. Just like with Part A, recipients automatically receive Medicare Part B coverage as soon as they enroll in Medicare. Recipients will, however, pay Part B premiums monthly.

Part B covers outpatient services that are officially deemed as either:

  • Medically necessary – Confirmed as needed to diagnose and treat the medical condition and a part of standard practice
  • Preventive – Deemed necessary to prevent an illness or treat a condition at an earlier and more-effective stage

Services that are covered include within these two categories are:

  • Doctor visits
  • Necessary medical tests and procedures
  • Preventive care
  • Medical supplies
  • Mental health services
  • Ambulances

Services not covered by Original Medicare must be paid 100% out-of-pocket, unless you have supplemental insurance to cover them. The other alternative is to enroll in a Medicare Advantage plan through a private insurance carrier.

What Does Medicare Part C Cover?

Medicare Part C, or Medicare Advantage, offers the same coverage as Original Medicare, but bundles the covered benefits with additional services. Medicare Advantage plans are available through private health insurance companies, which means that specific coverage varies.

Part C plans may cover services like:

  • Prescription drugs
  • Vision coverage
  • Hearing services
  • Basic dental care
  • Fitness programs
  • Transportation to and from medical appointments
  • Alternative services, such as chiropractic and acupuncture treatments

Medicare Advantage plans generally have fewer out-of-pocket costs and a yearly cap limit. Also, many of these plans do not charge a premium. However, you will still have to pay your Part B premiums. Copays and coinsurance costs vary depending on the carrier and type of plan you choose.

Medicare beneficiaries can enroll in a standalone Part D plan with Original Medicare, or obtain drug coverage through Medicare Advantage plans.

What Does Medicare Part D Cover?

Medicare Part D is a prescription drug plan that is available to anyone with Medicare. These plans are offered through private insurance companies. Beneficiaries can enroll in a standalone Part D plan with Original Medicare, or obtain drug coverage through Medicare Advantage plans.

Insurance carriers are required to publish a drug formulary, which is a list of prescription drugs covered by their Part D plans. They also must offer a standard level of coverage, as regulated and defined by Medicare. This includes the following drug categories:

  • Anticancer
  • Anticonvulsants
  • Antidepressants
  • Antipsychotics
  • Antiretrovirals
  • Immunosuppressants

Most Medicare Part D plans have a monthly premium, an annual deductible, and copayments for each prescription you fill. Specific costs vary depending on the insurance carrier and type of plan chosen.

How Do You Choose a Medicare Plan?

As with any healthcare decision, your final choice ultimately will be determined by finding the best option to suit your individual needs. When comparing Medicare options, it is important to consider a range of factors, including premiums, out-of-pocket costs, provider availability, referrals and extra benefits. You also need to think about your budget, lifestyle choices, and your current and future health considerations.

Once you narrow down your choices, it is a good idea to shop around and compare costs and benefits. This is particularly the case if you are considering a Medicare Advantage or Part D drug plan. It is also a good idea to seek help from a professional who can help you find the best coverage options in your area.