How Medicare Works

With so many connecting parts, Medicare can be a little overwhelming to think about. To help you out, we’ve pulled together some common scenarios to help you evaluate which coverage options are best for you.

Discover how Medicare Parts A, B, C and D all work together to get a better understanding of how Medicare Coverage works.

Assembling the Medicare Parts

Scenario #1

Original Medicare Only

PARTA

Hospital Insurance

Covers hospital and nursing home stays, and hospice care.

PART B

Medical Insurance

Covers doctor services, outpatient hospital care, durable medical equipment, and other medical services.

This chart is for illustrative purposes only and may not represent all potential coverage gaps.

Summary: Original Medicare is federal government program designed to help US citizens with healthcare costs as they age. When covered through Medicare you pay all deductibles, premiums, and copayments, and may experience gaps in your coverage depending on the length of care or stay at certain facilities. For most medical services you’ll be responsible for 20% of the total cost and there is no yearly maximum, or cap, on the amount you can spend out-of-pocket. In addition, Original Medicare does not include prescription drug coverage or additional benefits for vision, dental or health and wellness.

Find out how to cover the gap

Scenario #2

Medicare Advantage Without Drug Plan

PARTC

Medicare Advantage

Covers all Part A and B benefits, helps fill gaps in Part A and B.

PART A

Hospital Insurance

Covers hospital and nursing home stays, and hospice care.

PART B

Medical Insurance

Covers doctor services, outpatient hospital care, durable medical equipment, and other medical services.

This chart is for illustrative purposes only and may not represent all potential coverage gaps.

Summary: Medicare Advantage plans, also known as Medicare Part C, are offered through private insurance companies that have been approved and contracted by Medicare. They provide you with all of your Medicare Part A and B benefits, as well as additional coverage to fill many of the gaps where Parts A & B fall short. Most Medicare Advantage plans charge a monthly premium in exchange for consistent co-payments and deductibles and a yearly out-of-pocket spending maximum. You can enroll in Medicare Advantage Plans with or without prescription drug coverage. Signing up for a Medicare Advantage plan without prescription drug coverage can lead to a penalty.

Find out more about Tufts Medicare Advantage plans

Scenario #3

Medicare Advantage With Drug Plan

PART C

Medicare Advantage

Covers all Part A and B benefits, helps fill gaps in Part A and B.

PART A

Hospital Insurance

Covers hospital and nursing home stays, and hospice care.

PART B

Medical Insurance

Covers doctor services, outpatient hospital care, durable medical equipment, and other medical services.

PART D

Drug Insurance

Covers prescription drugs, as part of Medicare Advantage (Part C) coverage or through private insurance companies that have been approved by Medicare.

This chart is for illustrative purposes only and may not represent all potential coverage gaps.

Summary: Medicare Advantage (Part C) plans are offered through private insurance companies that have been approved and contracted by Medicare. They provide you with all of your Medicare Part A and B benefits, as well as additional coverage where Parts A & B fall short. By paying a monthly premium, you enjoy consistent co-payments and deductibles and a yearly out-of-pocket spending maximum. Some Medicare Advantage plans include Medicare Part D prescription drug coverage as illustrated in the graphic above.

Find out more about Tufts Medicare Advantage plans

Scenario #4

Original Medicare With Drug Plan

PART A

Hospital Insurance

Covers hospital and nursing home stays, and hospice care.

PART B

Medical Insurance

Covers doctor services, outpatient hospital care, durable medical equipment, and other medical services.

PART D

Drug Insurance

Covers prescription drugs, as part of Medicare Advantage (Part C) coverage or through private insurance companies that have been approved by Medicare.

This chart is for illustrative purposes only and may not represent all potential coverage gaps.

Summary: Adding Medicare Part D to your Original Medicare (Parts A & B) coverage provides you with access to prescription drug coverage, but the other costs and gaps in your Medicare Part A & B coverage remain.

Find out how to cover the gap

Scenario #5

Medicare Supplement Plan Without Drug Plan

PART A

Hospital Insurance

Covers hospital and nursing home stays, and hospice care.

PART B

Medical Insurance

Covers doctor services, outpatient hospital care, durable medical equipment, and other medical services.

SUPP

Medicare Supplement Plan

Insurance offered through private companies, approved by the Department of Insurance (DOI), to help fill the gaps in Medicare Part A and B coverage.

This chart is for illustrative purposes only and may not represent all potential coverage gaps.

Summary: A Medicare Supplement plan is third-party insurance you can purchase to help fill the coverage gaps in Original Medicare (Parts A & B), which remains your primary insurance. These gaps include out-of-pocket expenses like deductibles, co-pays and co-insurance. Signing up for a plan without purchasing separate Part D prescription drug coverage can lead to a penalty.

Find out how to cover the gap

Scenario #6

Medicare Supplement Plan With a Drug Plan

PART A

Hospital Insurance

Covers hospital and nursing home stays, and hospice care.

PART B

Medical Insurance

Covers doctor services, outpatient hospital care, durable medical equipment, and other medical services.

PART D

Drug Insurance

Covers prescription drugs, as part of Medicare Advantage (Part C) coverage or through private insurance companies that have been approved by Medicare.

SUPP

Medicare Supplement Plan

Insurance offered through private companies, approved by the Department of Insurance (DOI), to help fill the gaps in Medicare Part A and B coverage.

This chart is for illustrative purposes only and may not represent all potential coverage gaps.

Summary: A Medicare Supplement plan is third-party insurance you can purchase to help fill the coverage gaps in Original Medicare (Parts A & B), which remains your primary insurance. These gaps include out-of-pocket expenses like deductibles, co-pays and co-insurance. You can get prescription drug coverage by purchasing a separate Medicare Part D plan.

Find out how to cover the gap

https://www.tuftsmedicarepreferred.org/how-medicare-works/how-medicare-works