Understanding How Medicare Works

The essential ABCs (and D!) of Medicare

The Medicare program was designed in four parts, each part covering a different benefit category. As a Medicare eligible person, you will likely need and use a combination of these services depending on your health and as you get older.

Part A – Hospital Coverage


Most people who qualify for Medicare automatically get Part A coverage without having to pay a premium. Part A includes inpatient hospital care, long­‐term care in hospitals and treatment in a critical access hospital.


Part B – Medical Coverage


Part B covers your medically necessary doctors’ services and outpatient care. A Part B premium is deducted from your social security check each month to help pay the cost of this coverage.


Part C – Medicare Advantage Plans


If you have Part C, your coverage is provided by a private health plan called a Medicare Advantage plan. The health plans are contracted with Medicare. The coverage includes everything covered under Part A and Part B, except hospice care (Original Medicare continues to cover hospice care) and may include additional benefits not available with Original Medicare.


Part D – Prescription Drug Coverage


If you choose Part D coverage it will help lower your prescription drug costs. This coverage is available as a stand-alone plan, or may be included in a Medicare Advantage plan.

  1. Original Medicare only. This means that you have Medicare Part A and/or Medicare Part B only. Keep in mind, Medicare does not cover 100% of your medical and hospital costs, which will require you to meet a deductible and then pay a percentage of the cost of your care. Original Medicare also does not provide coverage for prescription drugs. For this, you need an additional standalone plan that may charge an expensive monthly premium.


  2. You purchase a Medicare Supplement. The supplement provides additional, variable coverage to fill in part or all of the gaps or costs not covered by by Original Medicare but the cost to you may be an expensive monthly premium.


  3. You select a Medicare Advantage Plan. A Medicare Advantage plan (Medicare Part C) includes all the healthcare benefits you are entitled to under Original Medicare, plus may include additional coverage as well as Part D coverage. Medicare Advantage plans, can however, choose not to cover the costs of services that are not medically necessary under Medicare. Medicare Advantage plans contract with the government to provide coverage to you, so you are still in the Medicare program, but you don’t need to use your Medicare card when you obtain medical services.


Want to get information faster regarding your COPC Senior Care Advantage options as a COPC patient? Contact the COPC Senior Care Advantage Advisor at MedicareInfo@COPCAdvantage.com.

Our COPC Senior Care Advantage advisors are specially trained to work with COPC patients to determine the Medicare coverage that is right for them. They understand the benefits of the COPC Senior Care Advantage program and have relationships with agents in Columbus that work with patients who are turning 65 who can assist with Medicare coverage decisions and plan benefit comparisons.

Many Medicare Advantage plans offer benefits that are ideal for helping you afford good healthcare coverage for current and future healthcare needs.

If you, like many people in their sixties and early seventies, find that you spend a lot of money on healthcare-for things like specialist visits, prescriptions and testing, a Medicare Advantage plan can help lower these costs with affordable copays on these services. A copay is a set, fixed amount of money that you pay as your share of the cost of care. You are still required to pay a monthly Part B premium as part of a Medicare Advantage plan.

Medicare Advantage plans offer a variety of benefits designed to help members save on their healthcare spending. Finding the right plan depends on reviewing the benefits of each plan with an experienced advisor. One way to do this is to make an appointment with a licensed agent, who can help you compare plans and understand which providers belong in the network and what the cost of any medications you are currently taking would be. Contact the COPC Senior Care Advantage Medicare Advisor for a referral to a license insurance agent that frequently works with COPC patients at MedicareInfo@COPCAdvantage.com. If you see a healthcare provider that doesn’t belong to the plan, your services may not be covered, or your costs could be higher. The licensed agents and Medicare advisors who have been working with COPC patients for many years can help guide COPC patients to select the option that’s right for them and to continue receiving care from the COPC doctors that they are seeing now and prefer.

It is very important to see your doctor as often as you need, to get care early when it is most treatable. When you call a licensed agent, he or she will discuss alternative benefit plans that can save you money on visits to the primary care or specialist doctor that you want to see.

Many Medicare plans offer lower copays on doctor visits, including specialists. You can find plans that let you choose your own doctors from a network, or list of participating doctors.

When you call, your licensed agent will help you find a plan that allows you to continue to see your current COPC doctor, as well as any specialists you may be seeing.

Receiving health care at a hospital can be very costly. However, many Medicare Advantage plans offer low copays on physician visits and include a limit on how much you pay for these services.


Each Medicare Advantage plan can charge different out-­of-­pocket costs, making it even more important to compare benefits and find the plan that’s right for your needs and budget. Original Medicare does not cover prescriptions, and adding a supplemental prescription plan can often cost you more in monthly premiums. However, many Medicare Advantage plans include prescription coverage for no additional cost.


Medicare Advantage plans offer a number of benefits for you that are not offered in Medicare Parts A and B plans. They often include dental, vision and hearing coverage, as well as additional benefits designed to help members save money and stay healthy to include:

  • Exercise facilities & nutritional programs


  • Transportation to and from medical appointments


  • Preventive testing and care