Medicare Health Plan Types
The Medicare health plan landscape can be complicated and ever-changing.
Reviewing the basic Medicare benefits provided by Original Medicare, which you might know as Medicare Part A and Part B, is just the start of our conversation.
Medicare costs are another important factor. Learn about out-of-pocket costs, such as monthly premiums, deductibles, coinsurance and copayments.
Medicare Advantage Plans
Medicare Advantage (Part C), offered by private insurers, is a Medicare health plan that takes the place of Parts A and B. Medicare Advantage adds additional benefits not covered by Medigap policies. So you will get all the benefits offered by Original Medicare plus services such as:
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Dentist Care
(coverage varies by plans)
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Eye Exams
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Gym Benefits
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Hearing Aids
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In-home Monitoring
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Over-the-counter Drug Benefits
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Transportation to Medical Appointments
Comes in Several Forms:
- Health Maintenance Organization (HMO) Plans
- Preferred Provider Organization (PRO) Plans
- Private Fee-for-Service (PFFS) Plans
- Special Needs Plans (SNPs)
Medicare Advantage plans can range from $0 to several hundred dollars a month.
Medicare open enrollment takes place from Oct. 15 – Dec. 7. That’s when all people eligible for Medicare can change their Medicare health plans and prescription drug coverage for the following year.
Medicare Supplement Insurance (Medigap Plans)
To help with costs not covered by Original Medicare, you can buy a Medicare supplement plan, also known as “Medigap.”
With Medigap, you can choose any doctor or hospital that accepts Medicare without network restrictions.
The cost of Medigap policies varies. According to AARP, the nationwide average is $226 a month.
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Coinsurance
The percentage you pay providers after you’ve reached your deductible.
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Copayments
Your share of medical costs for services like a doctor’s visit or medication. This is usually a set amount, rather than a percentage.
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Deductibles
Your cost for health care or prescriptions before Original Medicare, a prescription drug plan or your other insurance kicks in.
Original Medicare Coverage
Original Medicare is a Medicare health plan paid for by the federal government. It consists of Medicare Part A and Medicare Part B.
You’re eligible for Medicare benefits if you are:
- 65 or older
- Younger than 65 with disabilities
- Experiencing end-stage renal disease (kidney failure)
Covers health care services, such as:
- Home health care (limited)
- Hospice care
- Inpatient hospital care
- Lab tests
- Surgery
While Medicare will cover your inpatient hospital stay, it doesn’t cover long-term care or nursing home care.
For most people, Part A is free.
Covers outpatient care and basic
health services, including:
- Ambulance services
- Chemotherapy
- Diabetes care and supplies
- Doctors’ services
- Durable medical equipment, such as wheelchairs, crutches and hospital beds
- Immunizations, such as the flu and pneumococcal shot
- Medically necessary diagnostic X-rays
- Mental health care (outpatient)
- Orthotics and prosthetics
- Physical therapy
- Preventive services, such as screenings, tests and well visits
Medicare Part B coverage costs for 2022:
- Standard monthly premium is $170.10
- Annual deductible for all Medicare Part B beneficiaries is $233.00
In most cases, you will pay 20% of the Medicare-approved amount for each item or service
Prescription Drug Plans
To get prescription drug coverage, you’d need to buy a Medicare Part D plan. Plans vary based on the list of prescription drugs they cover. They also divide the medication into different pricing and tiers. Our “guides” can assist you in learning more about prescription drug coverage and any other Medigap and Medicare Advantage questions you have. We look forward to helping you! Call us at 1-888-414-4547.