Original Medicare
Offered by the Federal Government
Part
A
Hospital Insurance
Covers hospital and nursing home stays. and hospice care.
What's Covered
- Hospital expenses for inpatient hospital stays (e.g. meals, supplies, tests, accommodations)
- Skilled nursing facility care
- Nursing homes
- Hospice care
- Some part-time, medically necessary home health care (physical, occupational, and speech therapy)
- Some medical equipment (e.g. walkers and wheelchairs)
- Prescription drugs taken as part of inpatient hospital or skilled nursing facility treatment
Part
B
Medical Insurance
Covers doctor services, outpatient hospital care, durable medical equipment, and other medical services.
What's Covered
- Doctor office visits (primary care and specialists)
- Test & laboratory services
- Outpatient care
- Medical supplies & durable medical equipment
- Ambulance & emergency services
- Limited prescription drug coverage, including injections received in a doctor's office, certain oral cancer drugs, and certain drugs you get in a hospital outpatient setting
- You can see any Medicare provider, no referrals required
Part
A
+Part
B
What's Not Covered
- Routine eye exams & most eyeglasses
- Dental care & dentures (with only a few exceptions)
- Outpatient prescription drugs prescribed by your doctor
- Gym memberships or fitness classes
- Weight management programs
- Routine hearing tests
- Custodial care (help with bathing, dressing, using the bathroom & eating) at home or in a nursing home
- Long-term care (for information about paying for long-term care, visit longtermcare.gov or eldercare.gov
- Acupuncture
- Most chiropractic services
- Most care while traveling outside the United States
Coverage limitations apply. Learn more about coverage gaps and the cost of Medicare »
Additional Coverage
Offered by Private Insurance Companies
Part
C
Medicare Advantage
Insurance offered by Medicare-approved private companies to provide all the benefits of Part A and Part B plus additional things that Medicare doesn't cover.
Whats Covered
All the Benefits of parts
A + B Plus:
- Hearing
- Vision
- Health and wellness programs
- Many plans cover prescription drugs *
* Prescription Drug Coverage
Many Medicare Advantage plans cover prescription drugs within their plans. Some do not offer this service. Check the details of each plan to see whether or not prescription drugs are covered in the policy.
Benefits displayed above are for example purposes only. Actual benefits vary by plan.
Types of Medicare Advantage Plans
Private companies who offer Medicare Advantage plans usually offer a number of different plan options to suit your individual health and financial needs. You are free to choose any type of Medicare Advantage plan you want from any insurance company that is available in your area.
Plan Type
Health Maintenance Organization
Patients select a primary care physician (PCP) from within the network, and referrals to specialists go through your PCP.
Offered by Tufts Medicare Preferred
Preferred Provider Organization (PPO)
No network restrictions or referrals; premiums may be higher.
Not offered by Tufts Medicare Preferred
Private Fee-for-Service (PFFS)
The plan determines how much it will pay and how much you must pay for care. Not all providers may accept the plan’s payment terms. Also, if your plan has a network, you may pay more to see an out-of-network provider.
Not offered by Tufts Medicare Preferred
Why Get a Part C Medicare Advantage Plan?
Additional Coverage - Medicare Advantage plans typically cover vision, hearing, and health and wellness programs.
Filling Cost Gaps - Covers the cost of care that may fall outside the established scope or time frame of Original Medicare.
Managed Care - Our HMO plan offerings offer coordinated care within a network of care providers.
Filling the Medicare Gap »
Drug Coverage
Offered by Private Insurance Companies
Part
D
Prescription Drug Plan
Insurance offered by Medicare-approved private companies to cover the cost of prescription drugs for anyone who has Part A, Part B or Part C (if the Part C plan does not already include prescription drug coverage.)
As part of a Medicare Advantage Plan (Part C)
Your Medicare Advantage plan must include prescription drug coverage. (Some Medicare Advantage plans do not include prescription drugs.)
As a standalone add-on to Original Medicare (Parts A & B)
Standalone add-on plans include Medicare Cost plans, Medicare Private Fee-for-Service plans and Medicare Medical Savings Account plans.
IMPORTANT NOTE
You cannot have both of these plan options at the same time. If you do, you will be dis-enrolled in your Medicare Advantage plan (Part C) and returned to Original Medicare (Parts A & B.)
Different Medicare Advantage Plans Take Different Approaches
Private Fee-for-Service (PFFS)
These plans typically do not include prescription options, so you can join a stand-alone drug plan if you enroll in a PFFS plan.
Health Maintenance Organizations (HMO) and Preferred Provider Organization (PPO)
These plans typically do include prescription options, and require you to get your Medicare prescription drug benefits through the plan.
Part D Penalty Considerations
If you do not enroll in Medicare Part D when you first become eligible for Medicare you may pay a penalty if you need to enroll in Part D a later time. The penalty is applied to your Medicare Part D premium after your initial enrollment period has ended and you’ve gone 63 consecutive days without either Medicare Part D coverage or some other form of creditable prescription drug coverage. Creditable prescription drug coverage is alternate drug coverage (often through an employer or union) that covers the same prescription drug costs as standard Medicare Part D prescription drug coverage.
Part D Coverage Gaps (Donut Hole)
Regardless of how you elect to receive your Medicare Part D coverage, or which insurance provider you choose, there are coverage limitations and gaps that exist. The "Donut Hole" is one of these gaps, but it's proper name is actually the "Coverage Gap Stage".
How Do the Parts of Medicare Work Together?
There are a number of different options you can choose from when considering your Medicare insurance coverage. These options are best described by looking at a number of coverage scenarios.
