Get to know the Medicare basics, from terminology to eligibility.

Use this page as a quick reference guide to start talking in Medicare lingo and to better understand your options as you begin to shop plans.

The four parts of Medicare.

When we talk about Medicare, we try to be as specific as possible. That’s because Medicare is actually split into four distinct “parts” to provide flexibility in choosing the coverage you need.

Original Medicare is offered by the Federal Government & includes Part A & Part B

 

Part A (Hospital Care)

Part A helps cover inpatient care. It's available with no additional monthly premium for most people, and you pay a share of the cost for the services and benefits you use.

 

Part B (Medical Care)

Part B helps pay for visits to a doctor's office, outpatient care and a few other things. Part B has a monthly premium that is usually deducted directly from your Social Security check.

Note: Medicare Parts A & B (Original Medicare) do not include an out-of-pocket maximum limit per year or provide coverage for prescription drugs, extra dental, vision, or hearing care.

Medicare Part C & Part D refers to Medicare plans offered by private insurance companies.

 

Part C (Medicare Advantage)

Part C plans bundle all of your Part A and B benefits with extra benefits like dental, vision, hearing and fitness. Unlike Original Medicare, they have an out-of-pocket maximum limit so you can budget your healthcare costs. And many include Part D prescription drug coverage. Bright HealthCare Medicare Advantage plans are available for as low as $0 a month.

 

Part D (Prescription Drugs)

Part D plans help pay for your prescription drugs. You can enroll in a Part D plan or get your drug coverage with a Medicare Advantage plan that includes Part D. Not all plans are the same, so it's important to be sure the plan you choose includes prescriptions you take.

Dive deeper into your Medicare options.

You can continue browsing the resources available on our site. But if you’d prefer a more personal approach, consider attending one of our New to Medicare or Community Meeting events.

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The basic elements of Medicare eligibility.

To be eligible for Medicare, you must be a U.S. citizen or legal resident who has lived in the United States for at least five years in a row. Most people become eligible for Medicare when they turn 65. Adults under the age of 65 with certain disabilities or medical conditions may also be eligible for Medicare. You can use Medicare.gov’s eligibility calculator for complete details on your eligibility, but make sure you come back here when you’re done to shop plans.

Commonly used Medicare Advantage cost terms.

As you compare plans, the following cost terms will help you evaluate which plan fits your coverage and budget needs.

  • Copay: After you pay deductibles, a copay is a fixed dollar amount you pay for the cost of a health-related service (like a provider visit) or supply (like medication). The insurer pays the rest.
  • Coinsurance: After you pay deductibles, coinsurance is the percent you pay for the cost of a fee or service. The insurer pays the rest.
  • Deductible: A set amount you must pay for healthcare before your insurance plan begins to pay.
  • Out-of-pocket maximum: The highest amount you will pay for medical services or supplies before your insurer pays the rest.
  • Penalty: A fee added to your monthly premium if you don’t join when you’re first eligible; applies to Part B or Part D only.
  • Premium: A monthly fee you may pay when you enroll in a plan. Not all plans have a premium.

As you explore your coverage options, you can also check your eligibility for the Extra Help program which provides assistance in paying for prescription drugs, premiums, deductibles, and more.

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Website Last Updated: Sept 30, 2022

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