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Medicare and Medicare Advantage. Part A, B, C. Part D. It can be so easy to confuse. Learn more about Medicare and Medicare Advantage to better understand what these references mean.

It was twenty years in the making when legislation passed for Medicare (Part A and Part B) in the summer of 1965. The population was growing and only one in eight seniors had health insurance.

In 1997, an additional program, Medicare+Choice (Part C) was created. The program was later renamed Medicare Advantage in 2003. During this time, the Medicare Drug Coverage (Part D) was also established.

This article will cover Part A through Part D.

Medicare, Part A and Part B

Medicare covers most persons aged 65 or older. You are automatically signed up for Medicare Part A and Part B – if you live in the U.S. and U.S. Territories (except for Puerto Rico) and are already getting Social Security, either through a disability or retirement.

You receive a packet of information a few months before you turn 65. And once you receive the information, you can choose to keep or decline Part B.

Those who live in Puerto Rico who already have Part A can sign up for Part B by completing an application, also available in Spanish.

If you are under 65, you are eligible for Medicare:

• If you receive Social Security Disability Insurance (SSDI), or certain Railroad Retirement Board (RRB) benefits for at least 24 months

While receiving SSDI or RRB benefits, you will get a packet of information when you receive your 25th month of benefits. And once you receive the information, you can choose to keep or decline Part B.

There is no waiting period for Medicare, if you have amyotrophic lateral sclerosis. Additionally, some people with End Stage Renal Disease may be eligible for Medicare.

Learn more about how and when to apply for Medicare.

Medicare covers most medically necessary services and supplies in hospitals, doctors’ offices, and other health facilities. But does not cover some services, like routine physical exams, eye exams, and most dental care.

Medicare Supplemental Insurance, Medigap, is also an option. You can purchase extra insurance from a private health insurance company to help pay for your share of out-of-pocket costs.

Free counseling from your local SHIP is available to help you with Medicare.

Medicare Advantage, Part C

Medicare Advantage is a private insurance option and another way to get your Medicare Part A and Part B coverage. Plans in Medicare Advantage must cover medically necessary services that Original Medicare covers.

For some services, Medicare Advantage Plans may use their own criteria to determine medical necessity. Plans may also offer some extra benefits that Original Medicare does not cover. Not all Medicare Advantage Plans work the same way. So, it is important to compare plans in your area.

What’s more, if you already have a preferred primary care doctor, consider checking to see if your doctor is part of the plan’s network before signing up. You can look on the plan’s website for a physician directory or call their customer service department.

Side-by-Side Comparison

To better understand your options, it is helpful to know some of the differences between Medicare (Part A, Part B) and Medicare Advantage (Part C):

You can also find more information, here.

Medicare Drug Coverage, Part D

Medicare drug coverage helps pay for prescription drugs and is optional. Coverage is offered to everyone with Medicare. It is important to note that if you do not get coverage when you’re first eligible, and you don’t have other creditable prescription drug coverage (such as drug coverage from an employer or union) you will likely pay a penalty if you join later.

Also note that there is a Medicare program to help those with limited income and resources. “Extra Help” is a program that helps pay for Medicare drug coverage premiums, deductibles, coinsurance, and other costs. Those with full Medicaid coverage, those who receive help from a Medicare Savings Program from their state to pay Part B premiums, or those who receive Supplemental Security Income may be automatically enrolled. You can also apply for the program.

You can obtain Medicare drug coverage either through a Medicare drug plan or a Medicare Advantage Plan. For additional guidance, read 5 tips for choosing Medicare drug coverage.

Enrollment Period

You can only join Medicare during certain times. Two key periods include:

Initial Enrollment Period
(new to Medicare)

• Starts 3 months before you get Medicare and ends 3 months after you get Medicare

Open Enrollment Period
October 15-December 7

• You can join, drop, or switch to another Medicare Advantage Plan (or add or drop drug coverage)

• Switch from Original Medicare to a Medicare Advantage Plan or from a Medicare Advantage Plan to Original Medicare

• Join, drop, or switch to another Medicare drug plan if you’re in Original Medicare

More guidance is available, here.

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Additional Resources

• Watch a video to learn more about Medicare Enrollment Fraud

• Find and compare providers near you

• Know your Medicare rights and protections

• Learn more about avoiding late enrollment penalties

• If you need to contact Medicare, call 1-800-633-4227 or start a live chat. TTY users can call 1-877-486-2048

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