Part A, B, C, & D
TL:DR (AKA Too Long, Didn’t Read. As the kids say!)
A is hospital insurance, $0 premium for most people (AKA Original Medicare).
B is medical insurance, unless on Medicaid, you will have a premium. B enables you to see doctors, get procedures, etc.. with a 20% fee to you on every bill (AKA Original Medicare).
C is Medicare Advantage, and is only applicable when you have Part A AND Part B. This helps cover that 20% you’d owe for just Part A & B. Also can include extra benefits like dental, vision, hearing, as well as prescription coverage.
D is Prescription Drug coverage. This is only for people with Original Medicare (A&B only), or a Supplement/MediGap.
Part A is included in Original Medicare, which began in the 1960’s. Part A is hospital insurance, basically meaning it covers your stay while in hospital. Most people pay $0 for Part A as long as they/their spouse worked and paid into the Medicare tax. You/your spouse would need to work at least 40 quarters for the premium to be $0. You can sign up for Part A without signing up for Part B, 3 months before your 65th birthday month, the month of your 65th birthday, and the 3 months following your 65th birthday month. Thus giving you your Medicare ID number (aka MBI) and a Part A effective date. You can however bypass signing up for Part A if you have what is known as qualifying coverage. That means you have a current group health insurance plan that has more than 20 employees on said plan. However, if you do not sign up in time you will be hit with a monthly late penalty that can stick with you until death. Moral of the story, sign up for at least Part A ASAP. There is a late penalty calculator on our website, under “tools & links” which can be found within the resources section.
Part B is also included in Original Medicare, and this is known as your medical insurance. It covers every day things such as: doctors visits, labwork, outpatient services, imaging, etc… Part B does have a premium attached to it which changes by year and income. The year your Part B premium goes off of, is your two year prior tax return (i.e. 2026 Part B premium is based off your 2024 tax return. In this example the lowest Part B premium is $202.90 per month, per person and that can come right off the top pre-tax if you’re collecting Social Security benefits. If you aren’t, you’ll have to pay that premium yourself. If your income is higher, look for “IRMAA tax brackets” online for more information). Part B does NOT have an out of pocket maximum, it has a 20% coinsurance attached to it. If you have Original Medicare. Part A & Part B, and your bill is $100,000, you’d owe $20,000 with no cap for the year.
Back in the day, this is all people would have. Original Medicare AKA Part A & B, however this has now morphed into allowing you to get Part C (Medicare Advantage), Supplemental/Medigap plan, and/or Part D (Prescription Drug Coverage).
I always joke, A+B=us. Meaning once you have A & B you can talk to a broker/brokerage about your options.
Part C is what is known as Medicare Advantage (aka MA). These are what all the commercials we’ve seen for decades pertain to. Medicare Advantage can be national insurance companies or regional. They typically include: dental, vision, hearing, and prescription drug coverage (known as MAPD). They also (depending on your zip code) can include an over the counter card or a flex spending card to be used for copays. NOTE - when you see a commercial or hear an ad that says “you can get food” that is not applicable to everyone. You’d be shocked how many people reach out asking about that. Whatever plan your sibling, parent, in-law, neighbor, friend, cousin, have, is usually not the same as what you can get. Part C has an out of pocket maximum, could be say $5,500 for the year. Once you hit that number anything above and beyond the insurance company pays (again - these are written in very, very generalized scenarios, for further questions, reach out to a local broker). These plans can sometimes be as low as $0, and change yearly in terms of coverage and premium. If in a Medicare Advantage plan, you have the ability every year during Annual Enrollment Period, or AEP, to make a switch for the following year. AEP takes place from October 15 - December 7. There is what is known as Open Enrollment Period, OEP, which happens January 1 - March 31. During OEP you can make a 1 time switch for the year if the coverage you changed to or stayed in is not matching your current needs. Medicare Advantage plans tend to get a bad rap due to minimal coverage in some states. Yes, some states have worse options than others, but this is NOT the case in all states, zip codes, or counties. The key take away you should have from reading about Medicare Advantage, is talk to a local broker/brokerage. Not an 800 number. They will be able to go over any and all options in your area, and make sure to check they have access to all the carriers that are available to you.
Part D is Prescription Drug coverage. This is what will be billed for all your scripts throughout the year. Part D can work in 3 ways: 1. You can have Original Medicare only, Part A & B (don’t recommend that because of the 20% coinsurance), then this works for all meds. 2. It’s tied in with your Medicare Advantage, Part C, plan and you don’t need to buy a separate Part D. 3. You get a Supplement/Medigap plan and you need Part D coverage as well. Part D can also have a late penalty attached to it, similar to Part B premium, if you didn’t have qualifying coverage. As of this writing in 2026, the Part D deductible is max $615 for the year with an out of pocket maximum of $2,100. Which is up from 2025’s $2,000 maximum. There used to be what is known as the “Donut Hole” that is no longer applicable. Quick example, if you are on a brand name drug and you hit that $2,100 within the first quarter or so of 2026, you don’t owe on your scripts for the rest of the year. Whether you’re on an Advantage plan or Supplement, the Part D rules and regulations are all the same, regardless of insurance company.
