• Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). After you pay a deductible, Medicare pays its share of the Medicareapproved amount, and you pay your share (coinsurance). If you want Medicare drug coverage (Part D), you can join a separate Medicare drug plan.
• Medicare Advantage (also known as “Part C”) is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health coverage. These “bundled” plans include Part A, Part B, and usually Part D. Plans may offer some extra benefits that Original Medicare doesn’t.
In general, Medicare Part A helps pay for inpatient care you get in hospitals, critical access hospitals, and skilled nursing facilities. It also helps cover hospice care and some home health care.
Medicare Part B (Medical Insurance) helps cover 2 types of services:
Medically necessary services: Services or supplies that meet accepted standards of medical practice to diagnose or treat your medical condition.
Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage when treatment is likely to work best.
You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.
If you use an insulin pump that's covered under Part B's durable medical equipment benefit, or you get your covered insulin through a Medicare Advantage Plan, your cost for a month's supply of Part B-covered insulin for your pump can't be more than $35. The Part B deductible won't apply.
If you get a 3-month supply of Part B-covered insulin, your costs can't be more than $35 for each month's supply. This means you'll generally pay no more than $105 for a 3-month supply of covered insulin.
If you have Part B and Medicare Supplement Insurance (Medigap) that pays your Part B coinsurance, your Medigap plan should cover the $35 (or less) cost for insulin.
A Medicare Advantage Plan is another way to get your Medicare Part A and
Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are Medicare-approved plans. They’re offered by private companies that must follow rules set by Medicare.
Most Medicare Advantage Plans include Medicare drug coverage (Part D). In certain types of plans that don’t include Medicare drug coverage (like Medical Savings Account Plans and some Private Fee-for-Service Plans), you can join a separate Medicare drug plan. However, if you join a Health Maintenance Organization or Preferred Provider Organization Plan without drug coverage, you can’t join a separate Medicare drug plan.