Original Medicare

Administered by the federal government, and there are two parts to this program:

  • Part A, which is hospital insurance, covers eligible costs for your care as an inpatient in a hospital or skilled nursing facility. It also may cover hospice care.
    • People with qualifying work histories usually don’t pay a premium for their Part A coverage
  • Part B is your medical insurance and generally covers outpatient services such as doctor visits, outpatient tests, home health care, durable medical equipment, and certain preventive services.
    • Part B premiums are set each year at the federal level and you do not pay more because of your age or health condition, although you might have to pay a higher premium if your income level is above a certain amount.

There is no annual cap on your out-of-pocket expenses with Original Medicare.  Medicare Supplement plan (Medigap) helps with out-of-pocket costs Original Medicare doesn’t cover.  You can choose to enroll into a Medicare Advantage Plan which also has maximum out of pocket caps.

Original Medicare generally does not include coverage for prescription drugs, except those medications that must be administered by a medical professional, such as chemotherapy and certain types of injections, for example.

If you want prescription drug coverage and you are enrolled in Original Medicare, you’ll need to purchase a separate stand-alone Medicare Part D Prescription Drug Plan to have prescription coverage. 

Medicare Advantage Plans : Part C

Medicare Advantage (Part C) combines hospital and medical insurances.  It replaces Part A & Part B of original Medicare and offers additional benefits.  These plans usually require the member to use a network of providers.

Overview:

  • Plans can include lower cost and lower deductibles.
  • They have lower limits on out-of-pocket costs then Original Medicare.
  • Plans can range from HMO to PPO offering in and out of network options to get the provider flexibility you need.
  • Prescription Drug Coverage may be included
  • Some plans offer added coverage like dental, vision, hearing, and health and wellness programs.
  • Advantage plans have lower deductibles than Original Medicare.
  • Plans can have zero or low premiums.

Prescription Coverage

Part D helps pay for the costs of prescription drugs. Private insurance companies provide Part D coverage. You can purchase Part D as a stand-alone plan along with Original Medicare or packaged in with a Medicare Advantage plan.  If you do not enroll into Part D when you first become eligible penalties may apply.

  • Original Medicare generally does not include coverage for prescription drugs, except those medications that must be administered by a medical professional, such as chemotherapy and certain types of injections, for example.
  • If you want prescription drug coverage and you are enrolled in Original Medicare or Supplemental insurance, you’ll need to purchase a separate stand-alone Medicare Part D Prescription Drug Plan to have prescription coverage.

Medicare Supplement Plans also known as Medigap

Supplemental plans sometimes called Medigap supplement the Original Medicare (Part A and Part B) benefits by paying for some of the out of pocket cost of Original Medicare like copayment, co-insurance and/or deductibles.  Supplement plans are accepted by any Medicare provider

Currently, there are 10 standardized  Medigap plans, each represented by a letter (A, B, C, D, F, G, K, L, M, N; there’s also a high-deductible version of Plan F). the benefits of each plan within a lettered category remain the same despite the insurance company or location. For example, Plan A benefits are the same in New Jersey as they are in Oregon. If a Medicare Supplement plan includes a certain benefit, this benefit is covered 100{48e9a17823c826fdd137fd834d5a2b3e559614c0541675787c47c5447c73909b} unless otherwise specified.

In general, all Medicare Supplement plans cover the following benefits:

  • Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)
  • Medicare Part B coinsurance
  • Foreign travel emergency (up to plan limits)