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Medicare Part A & B: Basic Terms to Know


A payment request is submitted to CMS or your insurance providers for services that you believe are covered.


The overall cost for health care services or prescriptions must be paid before Medicare Advantage or other insurance plans will pay anything.


The amount paid by the insured party to the insurance company.

Long Term Care

Medical and non-medical care is provided to those who cannot perform simple daily tasks such as washing and dressing. These services can be provided in the home, in assisted living facilities, or in nursing homes.

Coverage: Simplified

Medicare Part A

Inpatient care in a hospital, Skilled nursing facility care, Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care), Hospice care, and Home health care.

Medicare Part B

Helps covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.

Medicare Part C

A Medicare Advantage Plan (like an HMO or PPO) is another health plan choice you may have as part of Medicare Part A & B, sometimes called “Part C” or “MA Plans,” are offered by private companies.

Medicare Part D

Helps cover prescription drug benefits.

Factors that Affect Rates

Certain parts of your profile affect your rates more than others, and every insurance company has its own specific formula to determine your premiums. 
Part A Premiums

Medicare Part A recipients do not pay any premiums if they are over 65 and:

  • Collect retirement benefits from Social Security or the Railroad Retirement Board.
  • Qualify for Social Security or Railroad benefits not yet claimed.
  • Employment with a Medicare Advantage-covered government agency.
  • Have at least 40 quarters of Medicare Advatage-covered employment.
  • And have at least 40 quarters of Medicare-covered employment.
Part B Premiums
Medicare Part B is a premium that changes annually, determined by modified adjusted gross income and your tax filing status. However, it will be more if you reported above a certain modified adjusted gross income on your federal tax return two years ago.
Part C Premiums
Premiums will vary depending on the insurance company you pick.
Part D Premiums
Premiums will vary depending on the insurance company you pick.

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[We do not offer every plan available in your area. Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. Please contact , 1–800–MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.]

“Participating sales agencies represent Medicare Advantage [HMO, PPO and PFFS] organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.”

Enrollment in the described plan type may be limited to certain times of the year unless you qualify for a Special Enrollment Period.