Medicare Basics | Wellcare

Learn more about your Medicare Advantage options.

Getting started with Medicare Advantage.

Whether you are turning 65 or just need to understand more about the basics of Medicare Advantage, Wellcare can help.

Understanding the basics means understanding your choices.

With so many Medicare coverage options to choose from, you may wonder where you should start. The chart below will help you learn more about the A, B, C, and Ds of Medicare.

Original Medicare

Part A

Inpatient Hospital Care

Nursing/Hospice Care

Exams

Outpatient Visits

Lab Tests/Imaging

Surgery

Medical Equipment

Wellness Services

Routine Vision

Routine Hearing

Prescription Drugs

Hospital Care Deductible (Part A)

Original Medicare

Part B

Inpatient Hospital Care

Nursing/Hospice Care

Exams

Outpatient Visits

Lab Tests/Imaging

Surgery

Medical Equipment

Wellness Services

Routine Vision

Routine Hearing

Prescription Drugs

Tests & Surgery Deductible

Medicare Advantage

Part C

Inpatient Hospital Care

Nursing/Hospice Care

Exams

Outpatient Visits

Lab Tests/Imaging

Surgery

Medical Equipment

Wellness Services

Routine Vision

Routine Hearing

Prescription Drugs

Tests & Surgery Deductible

Prescription Drug

Part D

Inpatient Hospital Care

Nursing/Hospice Care

Exams

Outpatient Visits

Lab Tests/Imaging

Surgery

Medical Equipment

Wellness Services

Routine Vision

Routine Hearing

Prescription Drugs

Tests & Surgery Deductible

Original Medicare: Parts A & B

Original Medicare is managed by the federal government and is just a starting point for your health care.

Part A covers in-patient medical hospital care, nursing facilities, hospice, and some home health care.

Part B helps cover doctor visits, outpatient care, and some preventive services.

You usually pay a monthly premium and must meet yearly deductibles

Covers 80% of the approved amount and you're responsible for the remaining 20%

Most prescription drugs, hearing aids, and routine dental care are not covered

No limit on yearly out-of-pocket costs

Medicare Advantage: Part C

Medicare Advantage is offered by private insurers and combines the benefits of Parts A & B plus other potential benefits.

Maximum out-of-pocket limit per plan year means 100% of allowed healthcare costs after you meet your out-of-pocket limit

Helps you control and understand your financial risk

Understanding the Value of Medicare Advantage plans.

When it comes to understanding the value of Medicare Advantage plans, you may have questions. Wellcare is here to help from the start. Learn more about your Medicare options in this quick video.

Common Types of Medicare Advantage Plans

Health Maintenance Organization (HMO)

Usually requires you to get most care and services from in-network providers

Costs are lower with in-network providers

Must choose a Primary Care Provider

Need referrals to see a specialist

Learn More

Preferred Provider Organization (PPO)

Provide you with a preferred network

Costs are lower with in-network providers

Costs are generally higher with out-of-network providers

There usually isn't a need to have a referral to see a specialist

Learn More

Dual Eligible Special Needs (D-SNP)

Designed to coordinate covered benefits and services if you qualify for both Medicare and Medicaid

Learn More

Medicare Advantage and Prescription Drug Coverage: Part D

If you rely on prescription drugs to maintain your health, you have several options for prescription drug coverage:

Some Medicare Advantage (Part C) plans include prescription drug coverage (MAPD)

If you have Original Medicare (Part A & B), you can purchase a Prescription Drug Plan (PDP)

Includes mail-order service to help you save money and time

You may need to pay a deductible

Stages of Coverage

01Deductible

The amount you pay before a plan covers your prescription drug costs, if applicable.

02Initial Coverage:

The plan pays its share of the cost, and you pay your share. This stage lasts until your payments and the plan’s payments total $5,030 for the year.

03Coverage Gap:

Begins when your drug costs and plan payments for the year reach $5,030. You will pay 25% of the cost for covered generic and brand-name drugs until your out-of-pocket costs for the year reach $8,000.

04Catastrophic Coverage:

If your out-of-pocket costs for prescription drugs reach $8,000, you will pay $0 for brand and generic drugs for the remainder of the year.