Understanding Medicare Parts A, B, C and D in Pennsylvania

Last updated: 10/5/2026

Medicare is divided into parts, and each part covers different services. Understanding what Parts A, B, C and D cover can make it easier to compare your options and choose coverage that fits your health needs and budget.

Medicare is the federal health insurance program for people age 65 and older, and for some people under 65 with certain disabilities or conditions, according to Medicare.gov. If you are approaching 65, qualifying because of a disability, or helping a loved one in Pennsylvania compare coverage, learning what each part of Medicare does is a good first step.

Key facts about the parts of Medicare

• Medicare has four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage) and Part D (prescription drug coverage).
• Original Medicare includes Part A and Part B.
• Medicare Advantage plans are offered by private insurance companies approved by Medicare. These bundled plans include Part A, Part B and usually Part D.
• Medigap policies work only with Original Medicare. You cannot buy a Medigap policy if you join a Medicare Advantage plan.
• Original Medicare does not have a yearly cap on what you pay out of pocket. Medicare Advantage plans have a yearly limit on out-of-pocket expenses for covered services. However, Medigap plans cover most costs not covered by Original Medicare.
• Original Medicare does not include prescription drug coverage, so you must purchase a Part D drug plan with Original Medicare.

What does Medicare Part A cover?

Medicare Part B is medical insurance. Medicare.gov describes two types of covered services. The first is medically necessary services, such as doctor visits, outpatient care, ambulance services and durable medical equipment. The second is preventive services, such as screenings and many vaccines. You pay nothing for most preventive services when you use a provider who accepts Medicare.

Part B works differently from Part A. You pay a monthly premium for Part B, along with an annual deductible. After you meet the deductible, you usually pay 20 percent of the Medicare-approved amount for covered services.

What is Medicare Part C (Medicare Advantage)?

Medicare Part C, better known as Medicare Advantage, is an alternative way to receive your Medicare benefits. You get your coverage through a private health plan approved by Medicare. These bundled plans include Part A, Part B and usually Part D, according to Medicare.gov.

Medicare Advantage plans work differently from Original Medicare in a few important ways. You may need to use doctors in the plan's network for your care to be covered and get approval for certain drugs or services before you receive them. Plans include a yearly limit on out-of-pocket costs, and most offer extra benefits that Original Medicare does not cover, such as vision, hearing and dental.

What does Medicare Part D cover?

Medicare Part D helps pay for brand-name and generic prescription drugs. It is optional coverage offered by private companies approved by Medicare. You can get drug coverage by joining a Part D plan alongside Original Medicare, or through a Medicare Advantage plan that includes drug coverage.

Each Part D plan has its own formulary, which is the plan's list of covered drugs. Because formularies differ from plan to plan, review whether your medications are covered before you enroll. Even if you take no medications now, Medicare recommends considering drug coverage when you first become eligible. This could help to avoid a late enrollment penalty later.

What is Medigap?

Medicare Supplement Insurance, commonly called Medigap, is extra insurance you can buy from a private company to help pay your share of costs that are not covered by Original Medicare, such as copayments, coinsurance and deductibles. Generally, you must have both Part A and Part B to buy a Medigap policy.

Medigap policies do not cover prescription costs, so you will need to buy a separate Part D plan.

Medigap policies are standardized and named by letters. According to Medicare.gov, in most states, there are 10 different Medigap plan types that are named by letters: A through D, F, G, and K through N. Pennsylvania is one of the states where these plans are standardized with these letters. Each lettered Medigap plan includes the same benefits no matter which insurance company sells it (although premium costs can vary). BlueReliance Medicare Supplement plans from Capital Blue Cross are available in Plans A, B, C, D, F, G, and N.

How do Original Medicare and Medicare Advantage compare?

Choosing between Original Medicare and Medicare Advantage is one of the biggest decisions you will make when you enroll. Medicare.gov's plan comparison highlights a few differences to consider:

Licensed representatives from Capital Blue Cross are here to help. You can schedule a time to speak with a licensed representative in Pennsylvania to ask questions about Medicare plans and learn more about your options. You can also speak to a licensed agent by calling 888.234.5707.

What is a Special Needs Plan (SNP)?

A Special Needs Plan is a type of Medicare Advantage plan that serves people with specific severe or chronic diseases, certain healthcare needs, or both Medicare and Medicaid. There are three types: Dual Eligible SNPs (D-SNPs), Chronic Condition SNPs (C-SNPs) and Institutional SNPs (I-SNPs). All SNPs must provide Medicare drug coverage, and each tailors its benefits and provider choices to the group it serves.

Capital Blue Cross member resources

If you are exploring Medicare in Pennsylvania, Capital Blue Cross offers Medicare plans in 21 counties across Central Pennsylvania and the Lehigh Valley. If you would like to learn more about Medicare, you can read about the four parts of Medicare, attend a free Medicare educational seminar, compare Medicare Advantage plans, or review Medicare Supplement options. You can also speak with a licensed agent at 888.234.5707.

FAQ

Is Medicare Part C the same as Medicare Advantage?

Yes. Medicare Part C and Medicare Advantage are two names for the same program. These plans are offered by private insurance companies approved by Medicare and bundle Part A, Part B and usually Part D into one plan.

What is the difference between Medicare Part A and Part B?

Part A is hospital insurance, which helps pay for inpatient hospital stays, skilled nursing facility care, hospice care and some home healthcare. Part B is medical insurance, which helps pay for doctor services, outpatient care and preventive services.

Do I need Medicare Part D if I have Original Medicare?

Original Medicare does not include most prescription drug coverage. Many people with Original Medicare join a Part D plan. Joining when you first become eligible could help you avoid a late enrollment penalty.

Can I have both Medigap and Medicare Advantage?

No. Medigap works only with Original Medicare. If you join a Medicare Advantage plan, you cannot buy a Medigap policy to cover your out-of-pocket costs.