Your guide to Medicare
Understanding Medicare is important. It can also be a challenge. We’re here to help. Blue KC has all the information and education you need to understand your Medicare options so that you feel confident in choosing the coverage that’s best for you.
What is Medicare?
Medicare is federal health insurance coverage for eligible individuals ages 65 and older. It is also available for individuals under age 65 with certain disabilities or medical conditions.
Medicare is the nation’s largest health insurance program for Americans made up of four parts – Parts A, B, C and D – designed to address your healthcare needs. It is administered by the Centers for Medicare and Medicaid Services (CMS).
Part A
Part A covers inpatient care provided in hospitals or skilled nursing facilities, home health care services and hospice care for the terminally ill.
Part B
Part B covers services from doctors and other healthcare providers, outpatient care, medical supplies, durable medical equipment and preventive services.
Part C
These bundled plans include the benefits of Part A and Part B and may cover prescription drugs or other benefit extras.
Part D
Part D is prescription drug coverage that includes the cost of outpatient prescriptions like generic and brand name drugs. Part D is offered by Medicare-approved private insurance companies with standardized benefits. You can get Part D coverage as a stand-alone plan if you are enrolled in Original Medicare or as part of your Medicare Advantage plan. Coverage and costs beyond the standards set by Medicare can vary and your choices depend on where you live.
Most Part D plans have a list of covered prescription drugs (formularies) and may also have a network of pharmacies in your area.
Catastrophic coverage
As of January 1, 2025, the Medicare Part D coverage gap, also known as the “donut hole,” has been eliminated. Instead, once your out-of-pocket prescription drug costs reach $2,000, you will enter the catastrophic coverage phase—where you pay nothing for covered medications for the rest of the year.
This change simplifies Medicare Part D by reducing overall drug costs and removing the previous cost-sharing structure. With the donut hole eliminated, Medicare Part D will now follow a three-phase design: deductible phase, initial coverage phase and catastrophic coverage phase.
Medicare Supplement
While Medicare Supplement plans are not part of Original Medicare, they can play an important role in your Original Medicare coverage. Also known as Medigap, Medicare Supplement plans vary in what they cover but help pay some of the healthcare costs not covered by Original Medicare. You must have Part A and Part B to enroll in a Medicare Supplement plan.
There are 10 Medicare Supplement plans (aka Medigap plans) standardized by the federal government so every plan with the same letter, like Plan G, offers the same benefits from every company, while the level of coverage varies by plan. Private insurers may offer some or all the plans.
