[[state-end]]
Introduction to Medicare
Coverage Choices
Get to know your coverage choices
Original Medicare coverage from the U.S. government
Coverage choices from private insurance companies
[[state-end]]
Get to know your coverage choices
When looking at coverage choices, there’s a lot to consider. You can enroll in Medicare Part A (hospital insurance), Medicare Part B (medical insurance) or both. Once you enroll in Original Medicare (Parts A & B), you may have other coverage choices, too, such as a Medicare Advantage plan (Part C), a Medicare prescription drug plan (Part D) or a Medicare Supplement insurance plan (Medigap).
[[state-end]]When looking at coverage choices, there’s a lot to consider. You can enroll in Original Medicare Part A (hospital insurance), Original Medicare Part B (medical insurance), or both. Once you enroll in Medicare, there are more coverage choices you can make. Consider a Medicare Advantage plan (Part C), a Medicare prescription drug plan (Part D), or a Medicare Supplement insurance plan (Medigap) to complete your Medicare coverage.
[[state-end]]
Choose to add one or both of the following to Original Medicare
Medicare Prescription Drug (Part D) Plan
Offered by private companies
OR Choose a Medicare Advantage plan
Medicare coverage choices from the U.S. government
Original Medicare (Parts A & B) is coverage provided by the federal government. It helps pay for hospital stays and doctor visits. But it doesn't cover everything—and it doesn't cover prescription drugs. Original Medicare has two parts: Part A and Part B. Let's learn more.
[[state-end]]
Original Medicare coverage from the U.S. government
Original Medicare, provided by the federal government, has two parts: Part A and Part B. Original Medicare Part A helps pay for hospital stays, while Original Medicare Part B helps pay for doctor visits.
Click on the blue bars below to learn more about what Original Medicare Part A and Original Medicare Part B cover.
[[state-end]]
Medicare Part A: Hospital coverage
| What’s covered: | What isn't covered: |
|---|---|
|
Hospital stays and inpatient care, including:
|
|
| What’s covered: |
Hospital stays and inpatient care, including:
|
|---|---|
| What isn't covered: |
|
Medicare Part B: Medical coverage
| What’s covered: | What isn't covered: |
|---|---|
|
|
| Part B coverage limits: Preventive services and screenings are covered on set schedules, like a yearly flu shot. Other services and supplies must be medically necessary to diagnose or treat a disease or condition. | |
| What’s covered: |
|
|---|---|
| What isn't covered: |
|
| Part B coverage limits: Preventive services and screenings are covered on set schedules, like a yearly flu shot. Other services and supplies must be medically necessary to diagnose or treat a disease or condition. | |
Original Medicare Part A: Hospital coverage
| What’s covered: | What isn't covered: |
|---|---|
|
Hospital stays and inpatient care, including:
|
|
| What’s covered: |
Hospital stays and inpatient care, including:
|
|---|---|
| What isn't covered: |
|
Original Medicare Part B: Medical coverage
| What’s covered: | What isn't covered: |
|---|---|
|
|
| Part B coverage limits: Preventive services and screenings are covered on set schedules, like a yearly flu shot. Other services and supplies must be medically necessary to diagnose or treat a disease or condition. | |
| What’s covered: |
|
|---|---|
| What isn't covered: |
|
| Part B coverage limits: Preventive services and screenings are covered on set schedules, like a yearly flu shot. Other services and supplies must be medically necessary to diagnose or treat a disease or condition. | |
Coverage choices from private insurance companies
There are also coverage choices offered by private insurance companies like UnitedHealthcare. These include Medicare Advantage (Part C) plans, Medicare Prescription Drug (Part D) plans and Medicare Supplement plans. Let's learn more.
[[state-end]]
Coverage choices from private insurance companies
Private insurance companies, like UnitedHealthcare, offer even more coverage options:
- Medicare Advantage (Part C) plans
- Medicare Prescription Drug (Part D) plans
- Medicare Supplement (Medigap) plans
Not all plans are available in all locations.
Click on the blue bars below to learn more about private insurance coverage options.
[[state-end]]
Medicare Advantage (Part C) plans: Many benefits, one convenient plan
Medicare Part C is Medicare Advantage. Medicare Advantage plans combine Part A and Part B benefits into one plan. Most also include prescription drug coverage and offer additional benefits not covered by Original Medicare, often with no additional premium.
| What’s covered: | What isn't covered: |
|---|---|
|
|
| What’s covered: |
|
|---|---|
| What isn't covered: |
|
Medicare Part C is known as Medicare Advantage. Medicare Advantage plans cover and combine Original Medicare Part A and Part B benefits into one plan. Most Medicare Advantage plans also include prescription drug coverage (Part D) and offer additional benefits not covered by Original Medicare, often with no additional premium.
| What’s covered: | What isn't covered: |
|---|---|
|
|
| What’s covered: |
|
|---|---|
| What isn't covered: |
|
Special Needs Plans (SNPs): Medicare Advantage plans designed for specific needs
If you have special health care or financial needs, you may qualify for a Special Needs Plan. All Special Needs Plans include drug coverage. Other benefits may include coordination of care, transportation to and from medical appointments, credits to buy everyday health items, and routine vision and dental coverage. There are four main types of Special Needs Plans:
- Dual-Eligible Special Needs Plans (DSNPs) for people who have both Medicare and Medicaid
- Chronic Special Needs Plans (CSNPs) for people living with severe or disabling chronic conditions
- Institutional Special Needs Plans (ISNPs) for people who live in a skilled nursing facility
- Institutional-Equivalent Special Needs Plans (IESNPs) for people who live in a contracted assisted living facility and need the same kind of care as those who live in a skilled nursing facility
If you have special health care or financial needs, you may qualify for a Special Needs Plan. All Special Needs Plans include prescription drug coverage. Some plans also include coordination of care, transportation to and from medical appointments, credits to buy everyday health items, and routine vision and dental coverage. There are four types of Special Needs Plans:
- Dual-Eligible Special Needs Plans (DSNPs) for people who have both Medicare and Medicaid
- Chronic Special Needs Plans (CSNPs) for people living with severe or disabling chronic conditions
- Institutional Special Needs Plans (ISNPs) for people who live in a skilled nursing facility
- Institutional-Equivalent Special Needs Plans (IESNPs) for people who live in a contracted assisted living facility and need the same kind of care as those who live in a skilled nursing facility
Medicare Prescription Drug (Part D) plans: Get help paying for the prescriptions you take
Medicare Part D is prescription drug coverage. You can get prescription drug coverage with a standalone Part D plan or with a Medicare Advantage plan that includes prescription drug coverage.
| What’s covered: | What isn't covered: |
|---|---|
|
|
| What’s covered: |
|
|---|---|
| What isn't covered: |
|
Medicare Part D is prescription drug coverage. There are several plan type combinations you can have with a Part D plan:
- As a standalone Part D plan
- As part of a Medicare Advantage plan that includes prescription drug coverage
- In addition to a Medicare Advantage Private Fee-for-Service (PFFS) plan
- In addition to a Medicare Supplement insurance plan
| What’s covered: | What isn't covered: |
|---|---|
|
|
| What’s covered: |
|
|---|---|
| What isn't covered: |
|
Medicare Supplement insurance plans: Get help paying some out-of-pocket costs
Medicare Supplement insurance, often called "Medigap," helps pay some of the out‑of‑pocket costs not paid by Original Medicare (Parts A and B). There are ten plans standardized by the federal government. Each is labeled with a letter. Each Medicare Supplement plan offers the same basic benefits no matter which insurance company sells it.
Plan F[[state-start:null,AL,AK,AS,AZ,AR,CA,CO,CT,DE,FL,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,MP,NE,NV,NH,NJ,NM,NY,NC,ND,OH,OR,PA,PR,RI,SC,SD,TN,TX,UT,VT,VI,VA,WA,DC,WV,WI,WY]] † [[state-end]]is also offered as a high-deductible plan by some insurance companies in some states. If you choose this option, this means you must pay for Medicare-covered costs (coinsurance, copayments, deductibles) up to the yearly deductible amount of $2,340 in 2020 before your policy pays anything.
Note: In Massachusetts, Minnesota and Wisconsin, there are different standardized plan options available.
| What’s covered: | What isn't covered: |
|---|---|
|
All Medicare Supplement plans provide these basic benefits:
Some plans also provide additional benefits including:
NOTE: Benefits and costs vary depending on the plan chosen. |
|
|
[[state-start:null,AL,AK,AS,AZ,AR,CA,CO,CT,DE,FL,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,MP,NE,NV,NH,NJ,NM,NY,NC,ND,OH,OR,PA,PR,RI,SC,SD,TN,TX,UT,VT,VI,VA,WA,DC,WV,WI,WY]] † Plan F is only available for consumers first eligible for Medicare before 1/1/2020. * NY: In New York, the Excess Charge is limited to 5%; PA and OH: Note: Under Pennsylvania and Ohio law, a physician may not charge or collect fees from Medicare patients which exceed the Medicare-approved Part B charge. Plans F and G pay benefits for excess charges when services are rendered in a jurisdiction not having a balance billing law; TX: In Texas, the amount cannot exceed 15% over the Medicare- approved amount or any other charge limitation established by the Medicare program or state law. Note that the limiting charge applies only to certain services and does not apply to some supplies and durable medical equipment; VT: Vermont law generally prohibits a physician from charging more than the Medicare-approved amount. However, there are exceptions and this prohibition may not apply if you receive services out of state. [[state-end]] **Care needed immediately because of an injury or an illness of sudden and unexpected onset. Benefit is 80% and beneficiaries are responsible for 20% after the $250 annual deductible with a $50,000 lifetime maximum for medically necessary emergency care received outside the U.S. during the first 60 days of each trip. |
|
| What’s covered: |
All Medicare Supplement plans provide these basic benefits:
Some plans also provide additional benefits including:
NOTE: Benefits and costs vary depending on the plan chosen. |
|---|---|
| What isn't covered: |
|
|
[[state-start:null,AL,AK,AS,AZ,AR,CA,CO,CT,DE,FL,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,MP,NE,NV,NH,NJ,NM,NY,NC,ND,OH,OR,PA,PR,RI,SC,SD,TN,TX,UT,VT,VI,VA,WA,DC,WV,WI,WY]] † Plan F is only available for consumers first eligible for Medicare before 1/1/2020. * NY: In New York, the Excess Charge is limited to 5%; PA and OH: Note: Under Pennsylvania and Ohio law, a physician may not charge or collect fees from Medicare patients which exceed the Medicare-approved Part B charge. Plans F and G pay benefits for excess charges when services are rendered in a jurisdiction not having a balance billing law; TX: In Texas, the amount cannot exceed 15% over the Medicare- approved amount or any other charge limitation established by the Medicare program or state law. Note that the limiting charge applies only to certain services and does not apply to some supplies and durable medical equipment; VT: Vermont law generally prohibits a physician from charging more than the Medicare-approved amount. However, there are exceptions and this prohibition may not apply if you receive services out of state. [[state-end]] **Care needed immediately because of an injury or an illness of sudden and unexpected onset. Benefit is 80% and beneficiaries are responsible for 20% after the $250 annual deductible with a $50,000 lifetime maximum for medically necessary emergency care received outside the U.S. during the first 60 days of each trip. |
|
Medicare Supplement insurance, often called "Medigap," helps pay some of the out‑of‑pocket costs not paid by Original Medicare (Parts A and B). There are ten plans standardized by the federal government. Each Medicare Supplement plan offers the same basic benefits no matter which insurance company sells it.
Plan F[[state-start:null,AL,AK,AS,AZ,AR,CA,CO,CT,DE,FL,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,MP,NE,NV,NH,NJ,NM,NY,NC,ND,OH,OR,PA,PR,RI,SC,SD,TN,TX,UT,VT,VI,VA,WA,DC,WV,WI,WY]] † [[state-end]]is also offered as a high-deductible plan by some insurance companies in some states. If you choose this option, this means you must pay for Medicare-covered costs (coinsurance, copayments, deductibles) up to the yearly deductible amount of $2,340 in 2020 before your policy pays anything.
Note: In Massachusetts, Minnesota and Wisconsin, there are different standardized plan options available.
| What’s covered: | What isn't covered: |
|---|---|
|
All Medicare Supplement plans provide these basic benefits:
Some plans also provide additional benefits, including:
NOTE: Benefits and costs vary depending on the plan chosen. |
|
|
[[state-start:null,AL,AK,AS,AZ,AR,CA,CO,CT,DE,FL,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,MP,NE,NV,NH,NJ,NM,NY,NC,ND,OH,OR,PA,PR,RI,SC,SD,TN,TX,UT,VT,VI,VA,WA,DC,WV,WI,WY]] † Plan F is only available for consumers first eligible for Medicare before 1/1/2020. * NY: In New York, the Excess Charge is limited to 5%; PA and OH: Note: Under Pennsylvania and Ohio law, a physician may not charge or collect fees from Medicare patients which exceed the Medicare-approved Part B charge. Plans F and G pay benefits for excess charges when services are rendered in a jurisdiction not having a balance billing law; TX: In Texas, the amount cannot exceed 15% over the Medicare- approved amount or any other charge limitation established by the Medicare program or state law. Note that the limiting charge applies only to certain services and does not apply to some supplies and durable medical equipment; VT: Vermont law generally prohibits a physician from charging more than the Medicare-approved amount. However, there are exceptions and this prohibition may not apply if you receive services out of state. [[state-end]] **Care needed immediately because of an injury or an illness of sudden and unexpected onset. Benefit is 80% and beneficiaries are responsible for 20% after the $250 annual deductible with a $50,000 lifetime maximum for medically necessary emergency care received outside the U.S. during the first 60 days of each trip. |
|
| What’s covered: |
All Medicare Supplement plans provide these basic benefits:
Some plans also provide additional benefits, including:
NOTE: Benefits and costs vary depending on the plan chosen. |
|---|---|
| What isn't covered: |
|
|
[[state-start:null,AL,AK,AS,AZ,AR,CA,CO,CT,DE,FL,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,MP,NE,NV,NH,NJ,NM,NY,NC,ND,OH,OR,PA,PR,RI,SC,SD,TN,TX,UT,VT,VI,VA,WA,DC,WV,WI,WY]] † Plan F is only available for consumers first eligible for Medicare before 1/1/2020. * NY: In New York, the Excess Charge is limited to 5%; PA and OH: Note: Under Pennsylvania and Ohio law, a physician may not charge or collect fees from Medicare patients which exceed the Medicare-approved Part B charge. Plans F and G pay benefits for excess charges when services are rendered in a jurisdiction not having a balance billing law; TX: In Texas, the amount cannot exceed 15% over the Medicare- approved amount or any other charge limitation established by the Medicare program or state law. Note that the limiting charge applies only to certain services and does not apply to some supplies and durable medical equipment; VT: Vermont law generally prohibits a physician from charging more than the Medicare-approved amount. However, there are exceptions and this prohibition may not apply if you receive services out of state. [[state-end]] **Care needed immediately because of an injury or an illness of sudden and unexpected onset. Benefit is 80% and beneficiaries are responsible for 20% after the $250 annual deductible with a $50,000 lifetime maximum for medically necessary emergency care received outside the U.S. during the first 60 days of each trip. |
|
Seven plan combination options
Medicare isn't one-size-fits-all. You can combine different plans, offered through the government and private insurance companies, to get the coverage that's a good fit for you. Keep in mind that your health care and budget needs may change over time. When they do, you can be assured there's an option for you.
There are seven different combinations of plans to choose from.
-
Original Medicare (Part A and/or Part B) alone
-
Original Medicare (Part A and/or Part B)
PLUS a standalone prescription drug plan (Part D) -
Original Medicare (Part A and/or Part B)
PLUS a standalone prescription drug plan (Part D)
PLUS a Medicare Supplement (Medigap) plan -
Original Medicare (Part A and/or Part B)
PLUS a Medicare Supplement (Medigap) plan -
Medicare Advantage plan (Part C) with prescription drug coverage (Part D)
-
Medicare Advantage plan (Part C) without prescription drug coverage (Part D)
-
Medicare Advantage Private Fee-for-Service plan without drug coverage (Part C)
OR a Medicare Savings Account (MSA) plan
PLUS a standalone prescription drug plan (Part D)