There are many different Medicare Plans available. Understanding all the options and deciding which plan is best for you cannot be obvious. In this article, we will look at Medicare explained quickly, outline all the different types of Medicare plans and help you decide which one is right for you. Remember that what works for one person might not work for another, so reaching out to a representative is vital to find the best plan for your needs.
What is Medicare, and what does it cover?
It is a federally-funded health insurance program available to eligible individuals 65 years or older and those under 65 with specific disabilities or end-stage renal disease. Medicare provides coverage for hospitalization, physician services, prescription drugs, and other health care needs.
There are four Medicare parts: Part A, Part B, Part C, and Part D.
- Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and home health care.
- Part B covers outpatient medical services such as doctor visits, preventive services, durable medical equipment, and home health care.
- Part C, also known as Medicare Advantage, is a way to get your Medicare coverage through a private insurance company. With Part C, you will still have Parts A and B, but you might also have extra benefits like dental, vision, and prescription drug coverage.
- Part D is the prescription drug coverage part of Medicare. You can get this coverage through a stand-alone or Medicare Advantage Plan that includes Part D coverage.
Original Medicare vs. Medicare Advantage
Original (Part A and Part B) is the traditional fee-for-service Medicare plan run by the federal government. Private insurance companies offer Medicare Advantage Plans (Part C) and must follow the rules set by Medicare. These plans typically include Parts A, B, and D, but some plans might offer extra coverage like dental, vision, or hearing.
The main difference between Original Medicare and Medicare Advantage is how you get your care. With Original Medicare, you can go to any doctor or facility that accepts Medicare. With a Medicare Advantage Plan, you will usually have to use doctors and facilities in the plan’s network.
Another difference is that Original Medicare doesn’t have a maximum out-of-pocket limit, so your costs could be high if you need a lot of care. Medicare Advantage Plans typically have an annual out-of-pocket limit, so your costs would be limited to a certain amount each year.
If you’re happy with your Original Medicare coverage, you don’t have to do anything when open enrollment comes around. You can do this during open enrollment if you want to switch to a Medicare Advantage Plan.
Medigap Plans vs. Medicare Advantage Plans
Another way to get coverage if you have Original Medicare is to sign up for a Medigap Plan. Medigap Plans are offered by private insurance companies, which help pay some of the costs that Original Medicare doesn’t cover, like deductibles, coinsurance, and copayments.
One of the main differences between Medigap Plans and Medicare Advantage Plans is that Medigap Plans only supplement your Original Medicare coverage. Advantage Plans can provide all your Part A and Part B coverage and offer extra benefits like dental, vision, or prescription drug coverage.
Another difference is that with a Medigap Plan, you will still have to pay your monthly Part B premium and the premium for your Medigap Plan. With a Medicare Advantage Plan, your Part B premium is usually included in the plan’s monthly premium.
If you’re happy with your Original Medicare coverage, you don’t have to do anything when open enrollment comes around. You can do this during open enrollment if you want to switch to a Medigap Plan or a Medicare Advantage Plan.
Choosing the best plan for you
There is no one best/better plan for everyone, and the best plan for you will depend on your individual needs and budget. When you are looking at plans, you will want to compare the following:
- Monthly premiums
- Out-of-pocket costs
- Network of doctors and facilities
- Prescription drug coverage
- Extra benefits
You can use the Medicare Plan Finder tool to compare different plans and find the one that best meets your needs. If you need help choosing a plan, you can contact your state health insurance assistance program (SHIP). SHIPs offer free, unbiased counseling to people with Medicare and their families.
Tips for enrolling in a Medicare plan
If enrolling, you will need to have your Medicare number and the date your Part A and Part B coverage began. You will also need to know the names, dates of birth, and Social Security numbers of any family members enrolling in the plan with you.
If enrolling in a Medigap Plan, you must have your Medicare number, and the date your Part A and Part B coverage began. You will also need to know your zip code and whether you want to purchase a Plan A, B, C, F, G, M, or N.
The cost of Medicare plans
The cost of Medicare plans can vary depending on your chosen plan and the coverage you need. Original Medicare has no monthly premium for most people. If you do have to pay a premium, it will be deducted from your Social Security benefits.
If you enroll, you will have to pay a monthly premium in addition to your monthly Part B premium. The premium amount will depend on the insurance company and your chosen plan. Medicare Advantage Plans typically have a monthly premium lower than your Part B premium. The premium amount will depend on the insurance company and your chosen plan. Some Medicare Advantage Plans have $0 monthly premiums.