4 Parts of Medicare Explained

Medicare is a federal program helping millions of seniors and individuals with disabilities access affordable medical care. 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. To enroll, you’ll need to be at least 65 or have a qualifying disability.

Part A helps cover the big stuff like:

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

Most people will be eligible for Part A, at no cost, thanks to payroll deductions taken during working years. If you aren’t automatically enrolled, you can sign up for Part A, if eligible, during your Initial Enrollment Period.

Part B helps cover routine care like:

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

Part B has a monthly premium. If you don’t sign up when you’re first eligible, your premium may cost more. You may also have to pay a late enrollment penalty. Most people have their Part B premium taken out of their Social Security check each month.

If you’re still working and have health insurance through your employer, you may be able to delay signing up for Part B. If you don’t have employer coverage and miss your first chance to enroll, you may have to pay a late penalty. This penalty can last as long as you have Part B. That means you’ll pay more each month for your coverage.

Medicare Part C, known as Medicare Advantage, offers extra benefits, like dental and hearing. Extras can vary from plan to plan so you'll want to compare your options. These plans, like Clover Health Medicare Advantage plans, are offered by private insurance companies approved by Medicare.

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

Original Medicare doesn't cover prescription drugs, so Part D is essential for many. This type of plan may be offered as a stand-alone plan or as part of a Medicare Advantage with Prescription Drug (MAPD) plan.

• Regulation: All plans must meet the minimum coverage level set by Medicare.
• Enrollment: 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.

Choosing the best health plan is about what works for you. To find your perfect match, think about your current coverage and how you actually use your benefits.

Consider Doctor Visit Copays

Think about how often you see your primary care physician or a specialist. If you manage a chronic condition like hypertension or diabetes, those office visits can add up. With Original Medicare (Parts A and B), you generally pay 20% of the Medicare-approved amount after meeting your deductible. In contrast, many Medicare Advantage (Part C) plans offer fixed, predictable copays—sometimes as low as $0 for primary care—so you know exactly what the cost is before you even walk through the doctor’s office doors.

Review Your Prescription Copays

Whether you take a daily medication for blood pressure or an occasional antibiotic, pharmacy costs fluctuate. Consider the convenience of your lifestyle: do you prefer walking into a local pharmacy, or would you benefit from the ease of mail-order home delivery? Many plans now offer 90-day supplies delivered right to your door, often at a lower cost than monthly refills, ensuring you never miss a dose.

Think About Your Freedom To Choose Your Doctor

If you have a specialist you’ve seen for years, you want to ensure you can keep that relationship. This is where Medicare Advantage PPO plans offer a distinct advantage. While Original Medicare allows you to see any provider that accepts Medicare, a PPO (Preferred Provider Organization) gives you the flexibility to see doctors both inside and outside of a plan’s network without needing a referral.

It is important to be aware of the trade-off: you will almost always pay more out of pocket when you see a doctor outside the network. While you have the freedom to choose any provider who accepts Medicare, staying "in-network" is how you keep your costs the lowest.

This "one-card" convenience simplifies your life by bundling hospital, medical, and prescription drug coverage into a single plan. Instead of managing multiple ID cards, you use just one for everything from your annual physical to your pharmacy refills—giving you a streamlined experience without sacrificing your choice of doctor.

Remember, Your Peace Of Mind Is Important

Health insurance is about more than just bills; it’s about the security of knowing you’re covered if the unexpected happens. Many people choose to move beyond Parts A and B because they want an "all-in-one" solution that limits their maximum out-of-pocket spending for the year—a financial safety net that Original Medicare does not provide.

You should also consider if you want extra help paying for things like dental exams, new eyeglasses, or even hearing aids—benefits typically not covered by Original Medicare. For more information, read our article, Why Medicare Advantage is a Popular Choice. If you want more predictable costs and extra perks, take a look at the Clover Health options in your area.

The Clover Health Editorial Team creates easy-to-understand Medicare content to help people learn about their coverage and options. Our articles are written and reviewed by licensed insurance experts, healthcare writers, and Clover's clinical specialists. Every article is checked for accuracy, clarity, and CMS compliance.

Sources

• Centers for Medicare & Medicaid Services (CMS) (2025) Original Medicare (Part A and B
• Medicare.gov. What Part A covers & What Part B covers and Medicare-Basics