The ABC’s of Medicare

Medicare has certain times of year when you can sign up or make changes to your plan. Missing these dates can lead to penalties or gaps in coverage. We’ll help you keep track so you can enroll on time and avoid costly mistakes.

The ABC’s of Medicare: A Simple Guide to Understanding Your Options

When you first hear about Medicare, it can sound like a confusing jumble of letters. Part A, Part B, Part C, Part D — what does it all mean? Don't worry. Think of Medicare like a puzzle, and each letter represents a piece that fits together to create your complete healthcare picture. Once you know what each part does, the whole system becomes much easier to understand, especially when choosing between the two main paths: Original Medicare vs. Medicare Advantage.

Part A: Hospital Coverage

Part A is the foundation of Medicare. It covers hospital stays, skilled nursing facility care, hospice services, and some home health care. For most people, Part A doesn't come with a monthly premium, because you've already paid into it during your working years through payroll taxes. However, there are still deductibles and coinsurance costs to consider for longer stays when you use these services.

Part B: Medical Coverage

Part B works hand in hand with Part A. It covers outpatient services such as doctor visits, preventive screenings, lab tests, X-rays, durable medical equipment, and some mental health services.

Unlike Part A, Part B does come with a monthly premium, which is set each year and may be higher based on your income (this is called the Income-Related Monthly Adjustment Amount or IRMAA). This premium is well worth it, as most essential preventive services are covered at a $0 cost to you.

Part C: Medicare Advantage

Part C, known as Medicare Advantage, is offered by private insurance companies approved by Medicare. These plans bundle together Parts A and B, and most also include prescription drug coverage (Part D). Medicare Advantage plans often go further by adding extra benefits like routine vision, dental, hearing aids, and fitness memberships.

Think of Part C as a convenient all-in-one option. Be aware that these plans often use defined provider networks (like HMOs or PPOs) and may require referrals for specialists. A key financial benefit is that all MA plans include an annual out-of-pocket maximum for medical services.

Part D: Prescription Drug Coverage

Part D was designed to help with the rising cost of prescription medications. It’s available as a standalone plan if you have Original Medicare (Parts A and B), or it may be included with a Medicare Advantage plan.

Each Part D plan has its own list of covered medications, called a formulary, so it’s important to make sure your prescriptions are included. You should also understand that most plans have different coverage stages, including the Coverage Gap (or "Donut Hole").

Financial Relief Note: The cost of a 30-day supply of insulin is currently capped at $35 in all Part D plans.

Putting It All Together: Your Two Medicare Paths

You can think of Parts A and B as the core of Medicare. Everyone who enrolls starts there. From there, you get to decide how to build on that foundation:

Original Medicare Path (Parts A & B): You can add Part D for prescriptions and a Medicare Supplement (Medigap) plan to cover your out-of-pocket costs (deductibles, copays, and coinsurance). This path offers the most flexibility, allowing you to see any doctor or hospital nationwide that accepts Medicare.
Medicare Advantage Path (Part C): This plan replaces the way you receive Parts A and B, often bundles in Part D, and adds extra benefits.

CRUCIAL RULE: You cannot have a Medicare Advantage (Part C) plan and a Medicare Supplement (Medigap) policy at the same time. You must choose one path or the other.

Making the Right Choice

The ABC’s of Medicare may look simple on paper, but the decisions you make have a big impact on your financial future and access to care. Trying to compare costs and benefits across these two very different paths is where most people struggle.

Get Expert Help Today

Local Medicare agents Jim Cable and Steve Milton are here to make Medicare easy. They can explain the critical differences, guide you through your options, and help you:

Compare the total annual cost of Original Medicare + Medigap versus a Medicare Advantage plan.
Understand if your personal income will trigger the IRMAA surcharge on Part B and D.
Verify if your doctors and prescriptions are covered under each potential plan.

Medicare is all about choices — and you don’t have to make them alone.

Reach out to Jim Cable or Steve Milton today for your free Medicare consultation and get the peace of mind you deserve.

FAQ's

Frequently Asked Questions

Q: When should I sign up for Medicare?

Most people sign up when they turn 65. Your Initial Enrollment Period lasts for 7 months — 3 months before your birthday month, your birthday month, and 3 months after.

Q: What happens if I miss my Medicare enrollment window?

If you miss your Initial Enrollment Period, you may face late penalties and gaps in coverage. The good news is, we can review if you qualify for a Special Enrollment Period.

Q: What’s the difference between Medicare Advantage and Medicare Supplement?

Medicare Advantage (Part C) is an all-in-one alternative to Original Medicare that may include extra benefits. Medicare Supplement (Medigap) works alongside Original Medicare to help pay out-of-pocket costs.

Q: Do I need a prescription drug plan?

Yes, unless you already have creditable drug coverage. Medicare Part D helps cover prescription costs — and enrolling on time avoids late penalties.

Q: Will I be able to keep my doctor?

That depends on the type of plan you choose. Some plans have networks, while others let you see any provider who accepts Medicare. We’ll help you find a plan that works with your preferred doctors.

Q: Can I change my Medicare plan later?

Yes — you can review and switch plans during the Annual Enrollment Period each fall, or in certain cases with a Special Enrollment Period.

We provide reliable Medicare guidance designed to give you peace of mind. At Senior Health Insurance, we help secure your future—so you can focus on what truly matters.