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Understanding Medicare

Medicare can seem a bit overwhelming when it comes to what is and isn't covered. The first step in understanding Medicare is learning about its four "parts"— each of which covers a different area of health care costs and is designated by a letter, A through D.

Part A - Hospital Insurance

Medicare Part A helps cover your inpatient care in hospitals and skilled nursing facilities, excluding custodial and long-term care. It also helps cover hospice and some home health care. Typically, you become eligible for Part A when you turn 65, even if you’re still working. During your working years, you have probably paid for Part A through payroll deductions. For this reason, most people don’t pay a premium for Part A. You should be aware that Part A does not pay all of your hospital expenses; you are responsible for copayments and a deductible.

Part B - Doctor and Medical Insurance

Medicare Part B helps cover doctors’ services and outpatient care. It also helps pay for some preventive care and services Part A doesn’t cover, including physical and occupational therapy and some home health care (if these services are considered medically necessary). Most people must pay a monthly premium for Part B coverage. It’s important that you sign up for Part B when you become eligible; otherwise your Part B premium may be higher if you sign up late.

Parts A and B together cover much of the medical care you need, but not all of it. For example, Parts A and B (called Original Medicare) do not cover prescription drugs. This is where Parts C and D come into the picture.

Part C - Medicare Advantage

Medicare Part C, more commonly known as Medicare Advantage coverage, acts as an alternative to Parts A and B. This coverage is offered by private companies approved by and under contract with The Centers for Medicare and Medicaid Services (CMS). To join a Medicare Advantage plan, you must be enrolled in both Medicare Parts A and B. You must continue to pay your Part B premium and, usually, a monthly premium for the coverage.

  • Medicare Advantage plans provide all of the benefits of Part A and Part B coverage. Plus, they usually offer extra benefits not covered by Original Medicare, such as vision, hearing, dental, wellness programs and disease management programs.
  • Part D prescription drug coverage is often included in Medicare Advantage plans.
  • Unless your plan also provides out-of-network benefits, care is received from a primary care doctor, specialist or hospital in the plan’s network, except for emergencies and urgently needed care.

You have the convenience of one ID card, and you don’t have to pay separate premiums for your medical and prescription drug coverage.

Part D - Prescription Drug Coverage

It’s important to know that Original Medicare does not cover most prescription drugs. Medicare Part D was created to help lower your current prescription drug costs and help protect against higher costs in the future. Like a Medicare Advantage plan, Part D coverage is only available from private insurers that contract with Medicare.

  • Part D plans provide benefits for both brand name and generic prescription drugs at participating pharmacies.
  • Many people pair a Medicare Prescription Drug Plan with a Medicare Supplement plan.

The A,B,C,D's of Medicare

View Transcript

What is Medicare?

It’s a federal health insurance program for people who are age 65 or older, disabled, diagnosed with end-stage renal disease needing dialysis or a kidney transplant.

There are four basic parts to Medicare. They are called Parts A, B, C and D.

Let’s take a look at what each part covers and what it may cost you.

Part A covers hospital services, hospice care, care in a skilled nursing facility, some home health care.

Most people don’t pay a monthly premium for Part A.

Part B covers doctors visits, outpatient care, medical supplies, preventive services.

You generally have to pay a standard monthly premium for Part B. The premium is updated by the federal government each year and deducted from your Social Security check. Parts A and B are called Original Medicare and are run by the federal government.

Part C is also known as Medicare Advantage. It is a type of plan provided by private insurance companies that contract with the federal government.

Think of Part C as an all-in-one type of plan. It covers everything Parts A and B cover, and many plans provide extra benefits such as prescription drugs, dental, vision, hearing and more. Plus, when you enroll in a Medicare Advantage plan, there are people who help you coordinate your care. You are not on your own. Depending on your plan, you may pay a low or no monthly premium; preventive visits and screenings are covered at no cost; and unlike Original Medicare, there is an annual limit for out-of-pocket costs in case you get really sick.

Part D refers to prescription drug coverage provided by private insurance companies.

Part D covers generic and brand-name prescriptions. Before you purchase a plan, take a look at the drug list, also called a formulary, to make sure your medications are covered. You generally pay a monthly premium that varies by plan.

Get to know the basic parts of Medicare.

At Horizon Blue Cross Blue Shield of New Jersey, we want to help you understand your choices on your journey to better health.

ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-800-365-2223 (TTY 711).

ATENCIÓN: Si habla otro idioma que no sea inglés, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-365-2223 (TTY 711).

Horizon Insurance Company (“HIC”) has a Medicare contract to offer HMO, HMO-POS, PPO and Part D Medicare plans, including group-Medicare Advantage plans and group Part D Prescription Drug plans. Enrollment in HIC Medicare products depends on contract renewal. Products are provided by HIC. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. Both are independent licensees of the Blue Cross Blue Shield Association. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. © 2019 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105.

Frequently Asked Questions


“Original Medicare” is what most people refer to as simply “Medicare.” The term Original Medicare came into use after Medicare Advantage plans were introduced as an alternative to traditional/original Medicare benefits offered through the federal government.


When you are enrolled in Original Medicare, you are free to use any doctor, hospital or other health care provider who accepts Original Medicare. This applies to Medicare Supplement as well. With a PPO (Preferred Provider Organization) or POS (Point of Service) plan, you have the freedom to use any Medicare provider—even one that is not in your network. However, you may have higher out-of-pocket expenses if you use a non-network provider.


Original Medicare provides very limited coverage for prescription drugs, so most people find it helpful to have additional coverage. That’s why Medicare Part D was introduced. Medicare members now have the opportunity to get prescription drug coverage through a stand-alone Medicare Prescription Drug Plan (PDP), or as part of a Medicare Advantage plan that includes drug coverage (MAPD).


With Original Medicare and Medicare Supplement coverage, you do not need to choose a Primary Care Physician (PCP). With Medicare Advantage coverage, it depends on the specific type of plan. With HMO (Health Maintenance Organization) plans, you must select a PCP who will coordinate all of your care.


No referrals required for in-network specialists.


If you enroll in a plan that you feel is not meeting your needs, you may switch (or drop) your coverage during Medicare’s Annual Enrollment Period, which generally runs from October 15 through December 7 each year. Your coverage will begin on January 1 of the following year. In most cases, you must stay enrolled for that calendar year, starting with the date your coverage begins. In certain situations, however, you may be able to join, switch or drop plans during a special enrollment period. You can also make changes to your coverage during the Medicare Advantage Open Enrollment Period (MA OEP) which runs from January 1 through March 31 every year. Individuals may make only one election during the MA OEP.


Yes. If you're under 65 and have been approved for Social Security disability benefits, you automatically get Medicare Part A and Part B. Your Medicare benefits will begin after you have received disability benefits from Social Security or, if applicable, certain disability benefits from the RRB (Railroad Retirement Board), for 24 months.


Yes. You can register at for convenient and secure access to your personal Medicare information. You can use the site to track your health care claims; check your Part B deductible status; get information on your prescription drug coverage; sign up to get your "Medicare & You" handbook electronically; and much more.


Original Medicare pays for many health care services and supplies, but it doesn’t cover all your costs. Most people need additional private coverage to help pay for out–of–pocket costs.

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