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The 4 Parts of Medicare Explained

Medicare Part A and Medicare Part B make up Original Medicare.

What is Medicare Part A?

Medicare Part A is hospital insurance, and it’s more than what you think.

Part A covers:

  • Inpatient hospital care
  • Skilled nursing facility car
  • Nursing home
  • Hospice care
  • Surgery
  • Home health care
  • Hospital treatment drugs

What is Medicare Part B?

Medicare Part B is medical insurance, just what the doctor ordered.

Part B covers:

  • Doctor office visits
  • Outpatient care
  • Test and lab services
  • Ambulance & emergency services
  • Medical supplies
  • Some drugs

Original Medicare covers a lot, but not everything.

Medicare Part A and Medicare Part B do not cover:

  • Dental care
  • Routine eye exams & eyeglasses
  • Routine hearing tests
  • Custodial care
  • Long-term care
  • Outpatient drugs
  • Gym memberships
  • Weight management programs
  • Chiropractic services
  • Acupuncture

Medicare Part C and Medicare Part D

What is Medicare Part C, or Medicare Advantage?

Medicare Part C is health insurance made easy.

Private insurance companies created Medicare Part C, or Medicare Advantage. Part C includes Part A and Part B with some added benefits to cover the gaps. These benefits may include Part D prescription coverage, dental, vision, and fitness programs.

What is Medicare Part D?

Medicare Part D is drug coverage.

Private insurance companies provide Medicare Part D drug coverage for anyone who has Part A, Part B or Part C. The government requires Part D plans to offer certain drugs. These drugs are:

  • Anticancer
  • Anticonvulsants
  • Antidepressants
  • Antipsychotics
  • Antiretrovirals
  • Immunosuppressants

Medicare Advantage plans often come in multiple options. Choose the plan that best suits your needs

Types of Medicare Advantage Plans

Health Maintenance Organization (Medicare HMO)

Select a primary care physician (PCP) within the network and get all your referrals through them. Because you use one PCP to fulfill all your needs, it comes at a reduced price.

  • Use a PCP from within the network
  • Referrals to specialists go through your PCP. However, we do not require this.

Choose a Medicare BlueJourney HMO plan that meets your needs. 

Preferred Provider Organization (Medicare PPO)

Office visits to your family doctor are covered at a low copayment. We reimburse you for medically necessary benefits. It may cost more to get care from out-of-network providers except for emergency and urgent care.

  • No network restrictions or referrals
  • May have higher premiums

Choose a Medicare BlueJourney PPO plan that meets your needs.

Medicare Special Needs Plans (SNP)

These plans are designed to help people with certain health conditions. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.

Choose a Medicare BlueJourney Alliance SNP that meets your needs. 

Private Fee-for-Service (PFFS)

In this type of plan, the insurance company determines how much it will pay and how much you must pay for care. Currently, we don’t offer this type of Plan.

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Updated October 1, 2019