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Understanding Medicare: 
Parts A, B, C, 
and D

Medicare can be complex, but we’re here to break it down. There are four main parts of Medicare, each covering different healthcare needs.

The Four Parts of Medicare

  • Medicare Part A – Hospital Coverage

  • Medicare Part B – Medical Coverage

  • Medicare Part C – Medicare Advantage

  • Medicare Part D – Prescription Drug Coverage

What is Original Medicare?
(Part A & Part B)

Medicare Part A: Hospital Coverage

When you apply for Medicare, you are automatically enrolled in Part A. This covers:

  • Inpatient hospital stays

  • Home health care (e.g., after a stroke or major injury)

  • Hospice care

Most people do not pay a premium for Part A if they have paid Medicare taxes while working.

Medicare Part B: Medical Coverage

Part B covers:

  • Doctor visits

  • Lab tests and diagnostic screenings

  • Medical equipment

  • Ambulance transportation

  • Other outpatient services

Costs: Unlike Part A, Part B requires a monthly premium. For 2024, the standard premium is $185.00, with an annual deductible of $257. After the deductible, you typically pay 20% of the cost for covered services. If you are receiving Social Security benefits, your premium will be deducted from your monthly payment.

Co-Payments & Co-Insurance

Medicare uses an 80/20 co-insurance model—Medicare pays 80% of covered costs, and you pay 20%. However, Original Medicare does not cover:

  • Prescription drugs

  • Dental, vision, and hearing (except in emergencies)

  • Services from providers who don’t accept Medicare

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Medicare
Guide & Options

Medicare Prescription Drug Coverage (Part D)

What is Medicare Part D?

Part D is a voluntary prescription drug benefit through private insurance companies. Enrolling when you first become eligible prevents:

  • Coverage gaps

  • Late enrollment penalties

Having Part D ensures you have access to affordable prescription drugs and protection from high costs.

Medicare Enrollment Rules

Medicare has specific rules about when you can choose or change your Medicare plan. If you have any questions about your individual situation, we can help you determine whether you qualify for a Special Enrollment Period.

  • If you’re new to Medicare, you have three months before, the month of, and three months after your effective date to choose a plan.

If you qualify for certain situations, you may also be eligible for a Special Enrollment Period (SEP), allowing you to make changes to your plan outside of the usual enrollment periods.

Shop & Enroll in a Medicare or Life Plan Online

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    Prefer to explore plans on your own? Get instant quotes and enroll in a plan that fits your needs—all from the comfort of your home.

    ✔️ Compare Plans – See options from top providers.
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FAQs

  • Types of Medicare Advantage Plans

    You can generally join one of the following types of Medicare Advantage Plans:

    1. Health Maintenance Organization (HMO)

    2. Preferred Provider Organization (PPO)

    3. Private Fee-for-Service (PFFS)

    4. Medical Savings Account (MSA) Plan

    Eligibility Requirements

    To join a Medicare Advantage Plan, all of these must apply:

    • You live in the service area of the plan you want to join. The plan can provide more information about its service area. If you spend part of the year in another state, ask if the plan will cover you there.

    • You have Medicare Part A and Part B.

    • You do not have End-Stage Renal Disease (ESRD).

  • Medicare Advantage Plans (Part C)

    Medicare Advantage Plans, also known as “Part C” or “MA Plans,” provide an all-in-one alternative to Original Medicare. Offered by private companies approved by Medicare, these bundled plans include:
    Medicare Part A (Hospital Insurance)
    Medicare Part B (Medical Insurance)
    Usually Medicare Part D (Prescription Drug Coverage)

    What’s Covered?

    Medicare Advantage Plans cover all services included in Original Medicare. Some plans also offer extra benefits like:
    🔹 Vision
    🔹 Hearing
    🔹 Dental

    Plan Rules & Costs

    Medicare pays a fixed amount each month to companies offering Medicare Advantage Plans. Each plan sets its own out-of-pocket costs and may have different rules, such as:
    ✔ Requiring referrals to see specialists
    ✔ Limiting care to in-network providers

    Rules & costs may change each year. Contact us to learn more.

    Drug Coverage in Medicare Advantage Plans

    Most Medicare Advantage Plans include prescription drug coverage (Part D). However, certain plans:
    🔹 Cannot offer drug coverage (like Medicare Medical Savings Account plans)
    🔹 Choose not to offer drug coverage (like some Private Fee-for-Service plans)

    If you’re in an HMO or PPO Medicare Advantage Plan and join a separate Medicare Prescription Drug Plan, you’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.

    Medicare Supplement Insurance (Medigap) & Medicare Advantage

    Medigap policies cannot be used with Medicare Advantage Plans. To learn more about your options, contact Total Care Consultants.

  • How to Switch Your Medicare Advantage Plan

    If you're already enrolled in a Medicare Advantage Plan and want to switch, follow these steps:

    Switching to a New Medicare Advantage Plan

    1. Join the new plan during one of the Medicare enrollment periods.

    2. You’ll be automatically disenrolled from your old plan when your new plan’s coverage begins.

    Switching to Original Medicare

    1. Contact your current plan or reach out to Total Care Consultants to assist with the process.

    Important Considerations

    • Medicare Prescription Drug Coverage (Part D): If you don’t have other drug coverage, you should consider enrolling in Part D.

    • Medicare Supplement Insurance (Medigap): You may also want to explore Medigap policies to help with additional costs.

    • Switching Timeframe: You can only switch during certain enrollment periods.

    If You Have Other Coverage

    • Before joining a Medicare Advantage Plan, talk to your employer, union, or other benefits administrator about your options.

    • Potential Coverage Loss: Joining a Medicare Advantage Plan might cause you to lose your employer or union coverage. If you lose coverage, you might also lose coverage for your spouse or dependents.

    • In some cases, you may still be able to use employer or union coverage alongside the Medicare Advantage Plan, but dropping it may prevent you from getting it back.

  • At the end of the year, Medicare Advantage Plans can choose to leave the Medicare Program. If this happens, you will receive a letter explaining your options.

    Your Options if Your Plan Leaves Medicare:

    Automatically Return to Original Medicare – If you don’t select a new Medicare Advantage Plan, you’ll be automatically enrolled in Original Medicare (Part A & Part B).

    Right to Buy a Medigap Policy – You may be eligible to purchase a Medicare Supplement (Medigap) policy to help cover additional costs.

    Medicare Prescription Drug Coverage (Part D) – If you return to Original Medicare, you’ll need to decide if you want prescription drug coverage. To get this, you must enroll in a Medicare Prescription Drug Plan (Part D) separately.

    ⚠️ No Matter What You Choose: You’ll remain in the Medicare Program and continue receiving all Medicare-covered services.

    Need help exploring your options? Contact us today!

  • Medicare Advantage & End-Stage Renal Disease (ESRD)

    If you have End-Stage Renal Disease (ESRD), you’ll usually receive health care through Original Medicare. However, you may be able to join a Medicare Advantage Plan (Part C) in specific situations:

    Who Can Join a Medicare Advantage Plan with ESRD?

    You were already enrolled in a Medicare Advantage Plan before developing ESRD. You may be able to stay in your plan or switch to another plan offered by the same company.

    You receive health benefits through an employer plan that is offered by the same organization providing the Medicare Advantage Plan.

    You had ESRD but received a successful kidney transplant. If you still qualify for Medicare based on age or disability, you can stay in Original Medicare or join a Medicare Advantage Plan.

    A Medicare Special Needs Plan (SNP) for ESRD may be available in your area.

    One-Time Right to Change Plans

    You have a one-time right to switch to another Medicare Advantage Plan if both of these apply:
    🔹 You have ESRD and are currently enrolled in a Medicare Advantage Plan.
    🔹 Your plan leaves Medicare or stops offering coverage in your area.

    ⚠️ Important: You don’t have to use this option immediately. If you return to Original Medicare after losing coverage, you still have a one-time right to join a Medicare Advantage Plan later.

    Need help understanding your options? Contact us today to find the right plan for you!

Get started with Total Care Consultants, today.

Contact Us

We’re dedicated to helping you navigate your Medicare and Medicaid options with confidence. Whether you have questions, need assistance enrolling in a plan, or want to explore your coverage choices, our knowledgeable team is here to guide you every step of the way.