Medicare Part A, B, C, and D: What's the Difference?
Open Enrollment for Medicare is coming up soon! From October 15 to December 7, you can make changes to your Medicare coverage that will take effect in January 2021. This is the time when you can:
Switch from Original Medicare to a Medicare Advantage plan (Part C) or vice versa.
Enroll in or switch Medicare Prescription Drug plans (Part D).
Choosing the right Medicare plan can feel overwhelming with so many options, so it’s helpful to understand what each part of Medicare covers and how they fit together. Here’s a breakdown to make it easier to understand.
Original Medicare (Parts A and B)
Original Medicare is federal insurance run by the government. It consists of two parts:
Part A: Covers hospital stays and other inpatient care.
Part B: Covers doctor visits, outpatient care, and other services like lab tests, physical therapy, and some preventive services.
What’s next?
If you have Original Medicare (Parts A and B), you can add Part D (prescription drug coverage) to help cover the cost of medications. You can also choose a Medigap plan, which helps pay for some of the out-of-pocket costs (like copayments or deductibles) that you may have under Original Medicare.
Tip: If you have a chronic condition like Hidradenitis Suppurativa, adding a prescription drug plan and a Medigap plan is a good idea. These extra plans help ensure that all your services and medications are fully covered.
Medicare Advantage (Part C)
Another option is Medicare Advantage (Part C), which is offered by private insurance companies that are approved by the government. With Medicare Advantage, your benefits from Parts A and B are bundled into one plan, and many plans also include extra coverage, like vision or dental care.
Medicare Advantage Plans may also include Part D coverage (prescription drugs), making them a one-stop option for many people.
Pros:
You’ll have all your benefits under one plan, which may feel simpler and easier to manage.
Many Medicare Advantage plans offer additional benefits like dental, vision, and wellness programs, which are not included with Original Medicare.
Cons:
Referrals: In most cases, you’ll need a referral from your primary care doctor to see a specialist, like a dermatologist or rheumatologist.
In-Network Care: You may need to see doctors or specialists that are in the plan’s network, which means fewer options than with Original Medicare.
Premiums: While Part A is usually free, you will still need to pay a premium for Part B and any additional Medicare Advantage plan premiums.
Medicare Part D: Prescription Drug Coverage
Part D is prescription drug coverage, which can help pay for your medications. If you have Original Medicare, you’ll need to add Part D separately. If you have a Medicare Advantage plan, most of them include Part D as part of the package.
Tip: If you take medications regularly (like for Hidradenitis Suppurativa), having a Part D plan is important to help keep your prescription costs down.
Medigap: Supplemental Coverage
A Medigap plan is additional insurance that can be added to Original Medicare to help cover out-of-pocket costs that Original Medicare doesn’t pay for, like copayments, coinsurance, and deductibles. Medigap plans are sold by private companies, and each plan offers a different level of coverage.
Choosing the Right Plan for You
With so many options, it’s important to think about:
Your Health Needs: If you have a chronic condition, like Hidradenitis Suppurativa, you may need more frequent doctor visits or prescription medications.
Cost: Consider your monthly premiums, out-of-pocket costs, and prescription costs.
Providers: Check if your preferred doctors and specialists are covered under the plan’s network.
The Medicare Plan Finder is a great tool to help you compare your options, check plan prices, and see how much each plan will cost you over the year. It helps you see which plans offer the best coverage for your needs, including any special coverage for prescriptions.
Get Help While Shopping for a Plan
Navigating Medicare can be tricky, but you don’t have to do it alone. Our Patient Support team is here to help! You can reach out for more information on Medicare Open Enrollment or get connected with in-person assistance to help you select the best Medicare plan for you.
