Medicare as Simple as A,B,C, & D

Then you’ve come to the right place. At Clover Health, we want to be your educational resource so that you can find the best possible Medicare plan. 

What is Medicare

Medicare is a health insurance program offered by the US federal government. It helps people who are over 65 and some younger people with disabilities to pay for medical care. It is a wonderful program helping millions of people, but it can be difficult to understand and navigate at times.

Most people have heard of Medicare but are not sure exactly what it is and what it offers. Is it free? Are you enrolled immediately when you turn 65? When it comes to Medicare, there are lots of questions. 

Medicare can be difficult to understand and can make choosing the best healthcare option difficult. That’s why we wanted to break it down into four simple parts.

The 4 Parts of Medicare

The Medicare health insurance program is divided into four parts: Parts A, B, C, and D. Parts A and B are known as Original Medicare.

Part A
Part A helps cover the big stuff like:            

• Hospitalization
• Skilled nursing facility                
• Hospice care
• Home health care

Most people will be eligible for Part A thanks to those payroll deductions taken during your working years. When you’re turning 65 and anytime after, you’re eligible for Part A even if you’re still working. If you aren’t automatically enrolled, you can sign up for free Part A, if you’re eligible, at any point during or after your Initial Enrollment Period. 

Part B
Part B helps cover routine care like:          

• Doctor appointments
• Outpatient care
• Preventive services
• Occupational/physical therapies
• Home health care

To qualify for Part B, you must enroll when you’re turning 65 and pay a monthly premium to avoid paying extra or having a gap in your coverage. Most people choose to have their Part B premium automatically withdrawn from their monthly social security check. 

If you’re delaying your retirement and have insurance with your employer, you can delay your enrollment in Part B. However, if this is not the case and you don’t enroll when you first become eligible for Part B, your Part B premium may be higher, and you may pay a late enrollment penalty.

Part C: Medicare Advantage

• Plans must include all Part A and Part B benefits.
• Many plans have no or low monthly premiums.
• Many plans include extra benefits and services like prescription drug coverage, dental, vision, and wellness.
• Plans usually have lower out-of-pocket expenses than Parts A and B.
• Plans are reviewed and approved by Medicare.
• You must be enrolled in both Medicare Parts A and B to join a Medicare Advantage plan.

Medicare Part C, commonly known as Medicare Advantage, offers extra coverage, such as vision, hearing, dental, and/or health and wellness programs, that may not be available with Original Medicare. Medicare Advantage plans, like Clover Health, are coverage offered by private insurance companies approved by Medicare and can provide additional lifestyle benefits in addition to the extra insurance coverage.

Part D: Prescription Drug Coverage

• This type of plan may be offered as a stand-alone plan or as part of a Medicare Advantage with Prescription Drug (MAPD) plan.
• All plans must meet the minimum coverage level set by Medicare.
• Similar to Part B, if you don’t sign up when you’re first eligible, the premium amount will increase each month until you enroll.

As you explore Medicare, it is important to look at your current and future needs to ensure you are receiving the necessary health coverage you will need. 

What Are Your Medicare Options

Option 1:  Original Medicare Only
Original Medicare helps to cover the big stuff in Part A, like hospitalization and routine care, and in Part B, like doctor appointments. However, Original Medicare only covers 80% of your Part B expenses. You are responsible for the remaining 20%, which can add up.

Option 2:  Original Medicare + a Part D Prescription Drug Plan
If you have Original Medicare and need coverage for prescription drugs, you may need to enroll in a Medicare Part D Prescription Drug Plan, often called a “standalone PDP.” That’s because Original Medicare doesn’t cover prescription drugs. Prescription drug plans are only offered by private insurance companies, so you will need to pay an additional monthly premium.

But what about coverage for the 20% of Part B expenses that Medicare doesn’t pay for?

Option 3:  Original Medicare + Medicare Supplement insurance (Medigap) + a Prescription Drug Plan
Many people buy Medicare Supplement Insurance, also known as “Medigap,” from private insurance companies to cover the remaining 20% of Part B expenses. Medigap plans cover some or most of the costs that Original Medicare doesn’t pay. These plans come with an additional monthly premium, which can be expensive.   

People buy the Medigap policy that best meets their coverage needs and budget. Usually, the more coverage you want, the higher the monthly plan premium you’ll pay. This could add up to several hundred dollars per month in premiums. 

Here are a few more factors to consider. Medigap plans are known to have high premiums, and rate increases are common. You can’t have Medigap coverage and Medicare Advantage coverage at the same time. And a Medigap plan can only be combined with the Original Medicare plan. But what about prescriptions? Medigap plans do not include prescription drugs. If you want coverage for your prescriptions, you will need to purchase a separate plan. 

Plus, you would need to pay an additional monthly plan premium for both your Medigap plan and your prescription drug plan and carry three cards: an Original Medicare card, a Medicare Supplement Insurance (Medigap) card, and a prescription drug card. 

Want dental and vision coverage? That’s more monthly premiums to pay and more cards to carry. 

Option 4:  Medicare Advantage (Part C)

 Advantages of a Medicare Advantage Plan

There may be an easier way to get your Medicare—through a Medicare Advantage plan. 
Medicare Advantage (or Part C) plans are offered through private companies, like Clover Health, contracts with Medicare (CMS). Medicare Advantage plans must have all the benefits of Original Medicare (Parts A and B). Many have $0 to low monthly premiums and low copays designed to lower your out-of-pocket expenses. They may also offer many benefits like:

• Prescription drug coverage, so you don’t need to buy a stand-alone Part D prescription drug plan. You’ll begin saving money right away.
• Allowances for dental, eyewear, and over-the-counter items
• Rewards program
• Fitness program

Medicare Advantage is convenient and easy: one plan, one card, one premium, and one company. That’s why millions of Medicare beneficiaries already have one.

One plan, one card, one premium, one company—easy!

 

Peace of Mind with Medicare Advantage

When you choose a Medicare Advantage plan from a private insurance company like Clover Health, you can have peace of mind knowing that:

•   You are still enrolled in Medicare
•   Every Medicare Advantage company has a contract with Medicare
•   Every plan includes all Part A and Part B benefits
•   Every plan is reviewed and approved by Medicare each year

 

To be eligible for a Medicare Advantage (MA) plan, also known as Part C, you must be enrolled in both Medicare Part A and Part B. Medicare Advantage plans are Medicare-approved plans administered by private insurance companies that provide all the benefits of Original Medicare (Medicare Parts A and B), often with additional coverage. 

How to apply for Medicare 

Have you learned enough about Medicare, and you are ready to apply? Before you apply, ensure you are eligible to apply and you are either turning 65, it is open enrollment, or it is a special enrollment period for you. To learn more, click here.

To apply for just Medicare, contact your local Social Security office. Depending on your status, you will be able to apply online, or they will have you fill out a special application. 

To apply for Medicare Advantage (Parts C), you will need to contact a local insurance plan in your state. 

When choosing a Medicare Advantage plan (Part C), Parts A and B will be included, and most plans will also include prescription drug coverage. 

How much do Medicare Part A and Part B cost 

For most people, Part A has no monthly premium. The standard Part B monthly premium in 2024 is $174.70; in 2025, that amount will increase by $10.30 per month to $185. This is automatically taken out of your Social Security check.

Medicare Part B premiums vary for each individual depending on your income level from two years before you sign up and your current situation.

Medicare Part C and Part D coverage costs can vary significantly based on the chosen plan. Many Part C plans, also known as Medicare Advantage, can have monthly plan premiums as low as $0. 

When examining Medicare costs, one should consider more than just the monthly premium amount. Copays, deductibles, and potential out-of-pocket costs will greatly impact future healthcare costs.

Many choose to purchase an all-in-one Medicare Advantage (Part C) plan to help manage healthcare costs and limit the yearly out-of-pocket expenses. 

The best way to know what a Medicare Advantage plan will cost you is to compare plans in your state. 

 

Should I get a Medicare Advantage plan?

Is a Medicare Advantage Plan the right option for you? To determine that, you must consider all of your healthcare needs. Does Original Medicare provide enough coverage for all your health care needs? Are you worried about high out-of-pocket expenses? A Medicare Advantage plan may be the perfect Medicare choice for you. 

To know for sure, take time to review the available Clover Health options in your area. 

Compare Medicare Advantage Plans in New Jersey, Georgia, Texas, South Carolina and Pennsylvania here: https://www.cloverhealth.com/en/plans