We’ve all experienced challenges in life, from moving to a new community to starting a new job to learning a new skill. At first, these experiences may have seemed a little daunting. But once you grasped the basics, they likely became easier. Then one day they became second nature.
The same can be said for mastering Medicare. By choosing a plan that best fits your needs, you’ll be better equipped to achieve your personal health goals. But selecting the right coverage starts with understanding the basics.
Read on to decode some of the more commonly misunderstood Medicare terms. (You might even be surprised to realize how much you already know!)
Medicare is the federal health insurance program for people 65 and older and younger people with certain disabilities. Read more on getting Medicare when you have a disability. Medicaid is a joint federal and state program that provides health coverage for people with limited incomes.
They mean the same thing. Original Medicare, the federal health program, includes two parts: Part A (hospital coverage) and Part B (medical care). Part A typically covers inpatient care in a hospital or skilled nursing facility, and home health care. Part B usually covers doctor visits and preventive services. Visit “Unpacking the Parts of Medicare” to learn more.
Both terms refer to the same thing. Instead of Original Medicare from the federal government, you can choose a Medicare Advantage plan (Part C) offered by a private insurance company. These plans include all of the benefits and services of Parts A and B. They may include prescription drug coverage as part of the plan. In addition, Medicare Advantage plans may offer extra benefits and services, such as vision, dental and hearing coverage, and fitness memberships. Visit “Unpacking Medicare Advantage” for more info.
Don’t be confused by these terms — they mean the same thing. For those on Original Medicare, you can buy additional coverage through private insurance companies to help pay for costs that are not covered, such as copayments, coinsurance and deductibles.
The donut hole refers to a gap in coverage, during which you may have to pay more for your prescription drugs. Here’s how it works:
This is a list of prescription drugs that’s covered by the plan. To lower costs, many plans place drugs into different tiers — or pricing categories — on their formularies. Drugs on each tier cost a different amount, and plans can structure their tiers in different ways. Generally, the lower the tier, the less you pay.
We’ve also included some basic health insurance terms that are helpful for understanding your Medicare coverage.
Now that we’ve covered the basics, you should be better prepared to make the right decisions to reach your health goals.
For a more complete list of terms, visit our Medicare glossary.
Sachi Fujimori is a writer and editor based in Brooklyn who focuses on writing about science and health. A good day is one where she eats her vegetables and remembers to live in the moment with her baby girl.
Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.
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