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The parts of Medicare (A, B, C, D)
Overview
There are four parts of Medicare: Part A, Part B, Part C, and Part D.
Generally, the different parts of Medicare help cover specific services. Most beneficiaries choose to receive their Part A and B benefits through Original Medicare, the traditional fee-for-service program offered directly through the federal government. It is sometimes called Traditional Medicare or Fee-for-Service (FFS) Medicare. Under Original Medicare, the government pays directly for the health care services you receive. You can see any doctor and hospital that takes Medicare (and most do) anywhere in the country.
In Original Medicare:
If you want prescription drug coverage with Original Medicare, in most cases you will need to actively choose and join a stand-alone Medicare private drug plan (PDP).
Note: There are a number of government programs that may help reduce your health care and prescription drug costs if you meet the eligibility requirements.
Unless you choose otherwise, you will have Original Medicare. Instead of Original Medicare, you can decide to get your Medicare benefits from a Medicare Advantage Plan, also called Part C or Medicare private health plan. Remember, you still have Medicare if you enroll in a Medicare Advantage Plan. This means that you must still pay your monthly Part B premium (and your Part A premium if you have one). Each Medicare Advantage Plan must provide all Part A and Part B services covered by Original Medicare, but they can do so with different rules, costs, and restrictions that can affect how and when you receive care.
It is important to understand your Medicare coverage choices and to pick your coverage carefully. How you choose to get your benefits and who you get them from can affect your out-of-pocket costs and where you can get your care. For instance, in Original Medicare, you are covered to go to nearly all doctors and hospitals in the country. On the other hand, Medicare Advantage Plans typically have network restrictions, meaning that you will likely be more limited in your choice of doctors and hospitals. However, Medicare Advantage Plans can also provide additional benefits that Original Medicare does not cover, such as routine vision or dental care.
Medicare Advantage
Medicare Part C is not a separate benefit. Part C is the part of Medicare law that allows private health insurance companies to provide Medicare benefits. These Medicare private health plans, such as HMOs and PPOs, contract with the federal government and are known as Medicare Advantage Plans. If you want, you can choose to get your Medicare coverage through a Medicare Advantage Plan instead of through Original Medicare.
Medicare Advantage Plans must offer, at minimum, the same benefits as Original Medicare (those covered under Parts A and B) but can do so with different rules, costs, and coverage restrictions. You also typically get Part D as part of your Medicare Advantage benefits package (MAPD). Many different kinds of Medicare Advantage Plans are available. You may pay a monthly premium for this coverage, in addition to your Part B premium.
If you join a Medicare Advantage Plan (like an HMO, PPO, or PFFS), you will not use the red, white, and blue card when you go to the doctor or hospital. Instead, you will use the membership card your private plan sends you to get health services covered. You will also use this card at the pharmacy if your health plan has Medicare prescription drug coverage (Part D).
Medicare Part D
Medicare’s prescription drug benefit (Part D) is the part of Medicare that provides outpatient drug coverage. Part D is provided only through private insurance companies that have contracts with the federal government—it is never provided directly by the government (unlike Original Medicare).
If you want to get Part D coverage, you have to choose and enroll in a private Medicare prescription drug plan (PDP) or a Medicare Advantage Plan with drug coverage (MAPD). Enrollment is optional (though recommended to avoid incurring future penalties) and only allowed during approved enrollment periods. Typically, you should sign up for Part D when you first become eligible to enroll in Medicare.
Whether you should sign up for a Medicare Part D plan depends on your circumstances. You may have creditable drug coverage from employer or retiree insurance. If so, you don’t need to enroll in a PDP until you lose this coverage. Also, some people already enrolled in certain low-income assistance programs may be automatically enrolled in a Medicare drug plan and receive additional financial assistance paying for their medicines.
Medicare cards
Everyone who enrolls in Medicare receives a red, white, and blue Medicare card. This card lists your name and the dates that your Original Medicare hospital insurance (Part A) and medical insurance (Part B) began. It will also show your Medicare number, which serves as an identification number in the Medicare system. (If you get Medicare through the Railroad Retirement Board, your card will say Railroad Retirement Board at the bottom.)
Source: cms.gov
If you have Original Medicare, make sure you always bring this card with you when you visit doctors and hospitals so that they can submit bills to Medicare for payment. If you have a supplemental insurance plan, like a Medigap, retiree, or union plan, make sure to show that plan’s card to your doctor or hospital, too, so that they can bill the plan for your out-of-pocket costs.
Note: Medicare has finished mailing new Medicare cards to all beneficiaries. You can still use your old card to get your care covered until January 1, 2020. However, if you have not received your new card, you should call 1-800-MEDICARE (633-4227) and speak to a representative.
If you are enrolled in a Part D plan (Medicare prescription drug benefit), you will use the Part D plan’s card at the pharmacy.
If you are enrolled in a Medicare Advantage Plan (like an HMO, PPO, or PFFS), you will not use the red, white, and blue card when you go to the doctor or hospital. Instead, you will use your Medicare Advantage Plan card, which you should receive in the mail. You will also use this card at the pharmacy if your plan serves as your Part D coverage. If you have a supplemental insurance plan, like a retiree or union plan, make sure to show that plan’s card to your doctor or hospital, too, so that they can bill the plan for your out-of-pocket costs.
Your Medicare card, Social Security card, and other health insurance cards are very important documents. Make sure to keep a photocopy of your important identification and insurance cards, write down any important numbers (like your Medicare number), and keep everything in a safe place so that you have a record for future reference if anything gets lost. If your card is ever lost, stolen, or damaged, you can get a replacement card by calling 1-800-MEDICARE (633-4227). You can also order or print a card by logging in to your mymedicare.gov account.
Remember: Do not give your Medicare or Social Security numbers or personal data to strangers. Medicare will never ask for this information over the phone. If you believe you have been the target of Medicare marketing or billing fraud, contact your local Senior Medicare Patrol.
When in doubt, call 1-800-MEDICARE or contact your local Medicaid office to learn more about Medicare and Medicaid
Choosing between Original Medicare and Medicare Advantage
People with Medicare can get their health coverage through either Original Medicare or a Medicare Advantage Plan (also known as a Medicare private health plan or Part C). Consider the following key differences between these two options when deciding how you want to receive your Medicare benefits.
- Includes Part A (inpatient/hospital coverage) and Part B (outpatient/medical coverage)
- Most doctors in the country take this insurance
- Medicare limits how much an individual can be charged when they visit participating or non-participating providers
- Beneficiary receives a red, white, and blue card to show to providers when receiving care
- Must provide the same benefits offered by Original Medicare, but may apply different rules, costs, and restrictions
- May also offer certain benefits that Original Medicare does not cover
- Some of the most common types of plans are Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Private Fee-For-Service (PFFS) plans
- Beneficiary shows the membership card from their plan when receiving care
If you sign up for Original Medicare and later decide you would like to try a Medicare Advantage Plan–or vice versa–be aware that there are only certain enrollment periods when you are allowed to make changes.
Note: Keep in mind that different areas have different Medicare Advantage Plans. A particular plan may not be available where you live. Call 1-800-MEDICARE or your State Health Insurance Assistance Program (SHIP) to find out about plans available in your area.
The table below compares Original Medicare and Medicare Advantage. Remember that there are several different types of Medicare Advantage Plan. If you are interested in joining a plan, speak to a plan representative for more information.
| Costs | You will be charged for standardized Part A and Part B costs, including monthly Part B premium. Responsible for paying a 20% coinsurance for Medicare-covered services if you see a participating provider and after meeting your deductible. | Your cost-sharing varies depending on plan. Usually pay a copayment for in-network care. Plans may charge a monthly premium in addition to Part B premium. |
| Supplemental insurance | Have the choice to pay an additional premium for a Medigap policy to cover Medicare cost-sharing. | Cannot purchase a Medigap policy. |
| Provider access | Can see any provider and use any facility that accepts Medicare (participating and non-participating). | Typically can only see in-network providers. |
| Referrals | Do not need referrals for specialists. | Typically need referrals for specialists. |
| Drug coverage | Must sign up for a stand-alone prescription drug plan. | In most cases, plan provides prescription drug coverage (you may be required to pay a higher premium). |
| Other benefits | Does not cover vision, hearing, or dental services. | May cover additional services, including vision, hearing, and/or dental (additional benefits may increase your premium and/or other out-of-pocket costs). |
| Out-of-pocket limit | No out-of-pocket limit. | Annual out-of-pocket limit. Plan pays the full cost of your care after you reach the limit. |
Annual changes and Medicare costs
Medicare premiums, deductibles, copayments, and other costs often change each year. The Centers for Medicare & Medicaid Services (CMS) typically announce changes in costs for the upcoming calendar year during late fall of the current year. This page will be updated as CMS releases information about costs for the upcoming year.
| Part A costs in 2022 | Premium if you have between 30 and 39 working quarters | $274/month |
|---|---|
| Premium if you have fewer than 30 working quarters | $499/month |
| Deductible | $1,556/benefit period |
| Inpatient hospital daily coinsurance for days 61 to 90 | $389/day |
| Inpatient hospital daily coinsurance for 60 lifetime reserve days | $778/day |
| Skilled nursing facility (SNF) daily coinsurance for days 21 to 100 | $194.50/day |
| Part B costs in 2022 | Premium | $170.10/month |
|---|---|
| Annual deductible | $233 |
| Part B Income-Related Monthly Adjustment Amount (IRMAA) in 2022 | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Your annual income | Your monthly premium in 2022 | ||||||||||
| Individuals | Couples | Equal to or below $91,000 | Equal to or below $182,000 | $170.10 | |||||||
| $91,001 -$114,000 | $182,001 – $228,000 | $238.10 | |||||||||
| $114,001 – $142,000 | $228,001 – $284,000 | $340.20 | |||||||||
| $142,001 – $170,000 | $284,001 – $340,000 | $442.30 | |||||||||
| $170,001 – $499,999 | $340,001 – $749,999 | $544.30 | |||||||||
| $500,000 and above | $750,000 and above | $578.30 | |||||||||
| Part D costs in 2022 | National average premium | $33.37/month |
|---|---|
| Annual deductible | $480 |
| Coverage gap begins | $4,430 |
| Catastrophic coverage begins | $7,050 |
| Part D IRMAA in 2022 | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Your annual income | What you pay in addition to your regular Part D premium | ||||||||||
| Individuals | Couples | Equal to or below $91,000 | Equal to or below $182,000 | $0 | |||||||
| $91,001 -$114,000 | $182,001 – $228,000 | $12.40 | |||||||||
| $114,001 – $142,000 | $228,001 – $284,000 | $32.10 | |||||||||
| $142,001 – $170,000 | $284,001 – $340,000 | $51.70 | |||||||||
| $170,001 – $499,999 | $340,001 – $749,999 | $71.30 | |||||||||
| $500,000 and above | $750,000 and above | $77.90 | |||||||||
Listed may change information changes from time to time.
When in doubt, call 1-800-MEDICARE or contact your local Medicaid office to learn more about Medicare and Medicaid.