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.

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)

Medicare Part A

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.

Medicare Part B

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 2023:

Standard monthly premium is $164.90
Annual deductible for all Medicare Part B beneficiaries is $226.00

In most cases, you will pay 20% of the Medicare-approved amount for each item or service

Medicare Supplement (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.

Medigap Insurance Helps Cover:

Coinsurance

The percentage you pay providers after you’ve reached your deductible.
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.
Deductibles

Your cost for health care or prescriptions before Original Medicare, a prescription drug plan or your other insurance kicks in.

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 plans. So you will get all the benefits offered by Original Medicare plus services such as:

Dentist Care (coverage varies by plans)
Eye Exams
Gym Benefits
Hearing Aids
In-Home Monitoring
Over-The-Counter Drug Benefits
Transportation to Medical Appointments

Medicare Advantage (Part C Plans)

come 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.

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 “Policy 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.