Medicare essentially breaks down into four different plans. But there are also some other supplemental plans associated with Medicare, as well such as Medigap. If you are thinking of getting Medicare, understanding the different plans is essential.
This will enable you to pick the right coverage and enjoy the benefits of a low-cost, government-sponsored healthcare program. With this Medicare comparison guide, you can understand how Part A and Part B work. Together known as Original Medicare, these two parts are critical to getting the most out of your Medicare coverage.
By signing up for Medicare, you can become eligible for other plans, as well; this is also discussed later on in the guide. If you have questions about any of this materials, you can always contact us or leave a comment.
Understanding Medicare plans – Getting started
In 2011, AARP noted that one baby boomer became eligible for Medicare every eight seconds. Are you quickly approaching the time to get Medicare? Then it’s time to start looking at different plans and finding the right option to take care of your health needs.
First of all, Medicare is a health insurance program that covers:
- Those who are aged 65 or older
- Those who are disabled
- Those who have amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease)
- Those whose parents or spouse are covered by Medicare.
Essentially, eligibility for Medicare depends largely on income and age.
There are several parts to Medicare. These include:
Original Medicare: Medicare Part A (hospital insurance plan)
Part A covers hospitalization, skilled nursing facilities and home health services, including hospice care.
Original Medicare: Medicare Part B (medical coverage)
Part B covers your doctor visitors, home healthcare, medical equipment charges, outpatient procedures, rehabilitation therapy, lab tests, X-rays, mental health programs, ambulances and bloodwork.
Medicare Part C (private health insurance)
Medicare Part C is also called Medicare Advantage (MA). These plans may also be called Medicare Health plans by private health insurance carriers. Before enrolling in a Medicare Advantage plan, you need to enroll in Original Medicare. If you decide that you want Medicare Advantage, you will choose a plan yourself and sign up with a private insurer. MA insurance plans are offered through private companies. But they’re sponsored by the government under Medicare, which lowers their costs.
Medicare Part C plans must pay for the same healthcare services as Original Medicare, under United States law. They may also include extras, such as vision, dental, hearing, wellness and prescription drug coverage (Part D).
Part D (Prescription Drug Coverage)
Prescription drug coverage is optional and available to those who have Original Medicare and Medicare Advantage. However, these plans are also offered through private health insurance companies. You sign up for Part D plans directly with private insurance companies. If you enroll in this program, you pay a monthly premium and also a deductible, in some cases. You also cover copays for any drugs that you need.
Comparing and choosing Medicare plans
Picking the right Medicare plan depends on a few different factors. If you decide to pick up Medicare coverage during the enrollment period, you will have one basic choice to make. Do you choose Original Medicare or Medicare Advantage?
In both cases, you pay a monthly premium for Part B coverage, which is typically $135.50 per month. There are plans under Medicare Advantage and Medigap that cover services not included in Original Medicare, such as dental, vision and hearing.
Here are some facts to consider when making your decision:
- Have you enrolled in an Original (or Traditional) Medicare plan?, You can select your own doctors. They must accept Medicare-approved amounts as full reimbursement for services rendered. If you add Medigap policies to Original Medicare, it will cover a portion of those expenses not covered by Medicare. This includes deductibles and copayments; it only applies to those doctors who accept Medicare.
- Have you enrolled in a Medicare Advantage plan?, Basic medical services are covered by Medicare, plus some extra costs. These plans are offered by private companies, which use extra services as incentives for you to sign up with their plans. This means that your MA plan could cover more health facilities, doctors, dental, vision, hearing and wellness services. You still pay a premium for Medicare Part B. And, you are still enrolled in Medicare and receive its protection. These plans also typically include prescription drug coverage.
- Have you enrolled in Original Medicare? You will need to buy prescription drug coverage (Part D). You will purchase additional prescription drug coverage from a private health insurance company to supplement your current prescription drug coverage.
- Have you purchased Original Medicare and supplemented coverage with Medigap? You get to pick your own doctors, as long as they accept Medicare. But you may pay more. Medicare Advantage plans offer HMO and PPO plans, which offer more or less flexibility. You are guaranteed to be able to pick your doctor with Original Medicare. But you will inevitably pay more and have to sign up for Medigap to cover other costs.
- Do you have a chronic illness? You may want to switch back to Original Medicare. One reason is because you can pick your own medical providers with Original Medicare. You still pay more under Original Medicare, because you have to pay for Part B, Part B and Medigap. But you will be able to go to any doctor or hospital that accepts Medicare. If you have a flexible Medicare Advantage Plan, such as a PPO or Pay-Fee-For-Service (PFFS), you may still be able to pick your own doctors. However, it might cost more to have one of these plans, instead of an HMO.
- Your location also makes a difference for Medicare Advantage eligibility. Most MA plans are available in urban areas, but only a few rural areas. Are you are moving or don’t live in a highly populated area? You might want to check if private health insurance companies in your area offer Medicare Part C plans.
Costs of Medicare Plans
You may want to compare plans by their costs. This section breaks down how much each plan costs and what you are paying for.
Medicare Part A and Part B costs
Medicare provides coverage for your healthcare. You have a choice of doctors, hospitals and other providers, only if they accept Medicare. For this, you pay a monthly premium for Part B, which is typically $135.50 per month. Deductibles and coinsurance are covered by you unless you receive supplemental coverage through Medigap. However, this typically costs less. You also must purchase a Part D drug plan separately.
Medicare Part C costs
Medicare Part C includes Part and Part B coverage. It is covered through private insurance companies that are approved by Medicare. For most plans, you must choose doctors and hospitals that are included within the plan’s network.
If you do not, you pay all of the costs out of pocket for your medical bills. You typically pay a monthly premium for Medicare Advantage and also a Part B premium. And, you pay a copayment or coinsurance for covered services. Coverages and other costs will vary, depending on the plan.
Medicare Part D costs
If you choose Original Medicare, you will join a Medicare Prescription Drug Plan with a private health insurance company and pay a premium. Plans must be approved by Medicare.
If you choose Medicare Advantage or Medicare Part C, prescription drug coverage is typically included in the plan. You can join a separate Medicare Prescription Drug plan if it’s not covered at first.
Medigap Costs and other supplemental coverage options
You may want to get a type of coverage that fills in the gaps if you choose Original Medicare. This is typically covered under Medigap policies. These supplemental policies are offered through private companies. Costs vary, depending on the policy and what company you select. You can’t use a Medigap policy if you have Medicare Advantage.
Hopefully, this Medicare comparison guide gives you a few tips to picking the best Original Medicare or Medicare Part C plans. Your decision largely depends on eligibility, income and health insurance needs. MedicarePartC.com has tons of articles that give you more information on the different parts of Medicare, as well as costs. If you have questions, you can always contact us to get more information.
You may also want to further explore this website, HealthNetwork.com. We offer a variety of Medicare Advantage policies that can meet your specific healthcare needs.