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Medicare Part A (Hospital Insurance)

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B (Medical Insurance)

Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.

Medicare Part C (Medicare Advantage Plans)

A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.

Medicare Part D (Prescription Drug Coverage)

Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

Understanding the 2021 Medicare drug payment phases 

What you pay for your covered drugs depends, in part, on which coverage phase you are in.

You will get an Explanation of Benefits (EOB) each month you fill a prescription. It will show which coverage phase you're in and how close you are to entering the next one.

Stage 1

Stage 2

Stage 3

Stage 4

Deductible phase

Initial Coverage phase

Coverage Gap phase

Catastrophic Coverage phase

During this phase, if your plan has a deductible, you'll pay the plan's negotiated lower cost up to the deductible limit.


Once you reach the deductible limit, you'll pay a copayment or coinsurance in the initial coverage phase.


During this phase, the plan will pay its share of the cost and you'll pay a copayment or coinsurance (your share of the cost) for each prescription you fill until your total drug costs reach $4,130.


Once you reach $4,130 you'll enter the coverage gap or "donut hole."


Most people will remain in this phase.

(Also known as the donut hole.)


During this phase, you'll receive limited coverage on certain drugs. For generics and brands, you'll pay 25% of the cost. This phase continues until your yearly out-of-pocket drug costs reach $6,550.


Once your yearly out-of-pocket costs reach $6,550, you'll move to catastrophic coverage.


Some people will move into this phase.

In this phase, you'll pay either a copayment or coinsurance amount for each prescription you fill. 


Few people with reach this phase.

Have questions about Medicare? Ask me about your Medicare options by calling 888-357-1999 or by sending a message request below to Medicare Options Info, Inc. A licensed independent insurance agent appointed with multiple carriers will help you make an informed decision. Agent is not connected in any way with the federal or state government or Medicare.

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