Medicare Basics | Wellcare

Learn more about your Medicare Advantage options.

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, 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, like vision, dental, hearing and much more.

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

Some plans include Part D (prescription) coverage, fitness benefits, and FREE over-the-counter health care items

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 (PCP)

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

Probably won’t need a referral to see a specialist

Learn More

Dual Eligible Special Needs Plans (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

Discount programs and subsidies are available for those with qualifying income

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 $2,000 for the year.

03Catastrophic Coverage:

Once your out-of-pocket costs for prescription drugs reach $2,000, you are no longer required to share costs beyond your plan co-pays for covered generic and brand name drugs.