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March 19, 2025
Understanding Your Medicare Coverage Options: Once you have enrolled in Part A (Hospital Insurance) and Part B (Medical Insurance) of Medicare, you have the flexibility to select the type of health coverage that best suits your needs.
Option 1: Choosing Between Original Medicare and Medicare Advantage
When seeking Medicare coverage, there are two primary alternatives available to you:
Original Medicare
- You pay for services as you receive them
- Medicare covers part of the cost, and you pay your share
- You can visit any doctor or hospital in the U.S. that accepts Medicare
Includes:
Part A (Hospital Insurance)
Part B (Medical Insurance)
Part D (Medicare Drug Coverage)
Supplemental coverage (to help pay your share of costs): Medicare Supplement Insurance (Medigap)
Medicare Advantage (Part C)
- You can enroll in a Part C plan from a private company that provides an alternative to Original Medicare for your health and drug coverage
- In many instances, you may only be able to see doctors who are part of the plan's network
Includes:
Part A (Hospital Insurance)
Part B (Medical Insurance)
Most plans include:
Part D (Medicare Drug Coverage)
Some extra benefits (that Original Medicare doesn’t cover – like certain vision, hearing, and dental services)
You must have both Part A and Part B to join a Medicare Advantage Plan.
Choice 2: If you picked Original Medicare, do you need to add more coverage?
Part D (Prescription Drug Coverage)
If you have Original Medicare and need prescription drug coverage, you can choose to enroll in a separate Medicare drug plan. This coverage is optional and accessible to all Medicare beneficiaries.
It's important to note that most Medicare Advantage Plans already include Part D coverage. Therefore, if you have this type of plan, you may not be eligible to join a separate drug plan.
These drug plans cover both brand-name and generic medications and each plan has a specific list of the drugs they cover, known as a "formulary." It's essential to be aware that the costs and the specific drugs covered can vary between different plans.
- There is usually a monthly premium for these plans, in addition to your Part B premium, as well as other costs for prescriptions.
- The covered drugs are divided into different cost tiers, where drugs in lower tiers are cheaper than those in higher tiers.
To make sure you don't get charged extra, you should sign up for a Medicare drug plan when you first get Medicare. If you wait too long—63 days or more without good drug coverage—then you may have to pay a penalty. The longer you wait, the more the penalty goes up. In most situations, you have to keep paying this extra cost every month as long as you have Part D coverage, even if you change plans. how much is the Part D penalty?
Medicare Supplement Insurance (Medigap)
Medicare Supplement Insurance (Medigap) is additional insurance that you can purchase from a private company to help cover your portion of costs in Original Medicare.
- Generally, having Part A and Part B is required to be eligible for purchasing a Medigap policy.
- Some Medigap policies provide coverage for when you travel outside the United States.
- Typically, Medigap policies do not cover long-term care (such as care in a nursing home), vision, dental, hearing aids, private-duty nursing, or prescription drugs.
- If you are under 65, you may have limitations on buying a Medigap policy or may have to pay a higher cost.
Medigap policies are standardized and are identified by letters in most states, such as Plan G or Plan K. The benefits within each plan indicated by a letter are the same, regardless of the company selling the policy.
The pricing is the only difference between policies with the same letter that are sold by different companies.
Additionally, enrolling in a Medicare Supplement Insurance (Medigap) policy can provide you with added financial protection by covering the portion of costs not already covered by Original Medicare. This extra coverage can help alleviate the burden of healthcare expenses, providing peace of mind and security for you and your loved ones.
Get the lowest price, To get the best price, make sure to buy a Medigap policy within 6 months of getting Part A and Part B. If you wait too long, you might not be able to buy a policy or you may have to pay more. Usually, you need to have Part A and Part B to buy a Medigap policy.
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