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Medicare Plans: What You Need for the Best Coverage

Sherrie Johnson Sherrie became a professional writer in 2014. An expert in all things Medicare, you can find her work across a number of publications. When she’s not writing, you can find her fixing up her farm in Kentucky where she lives with her husband.
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Which Medicare Plans are Right for You? Get the Coverage You Need

When navigating the world of health insurance and Medicare plans, information can be confusing and downright overwhelming. You need coverage but you’re not sure which insurance plan will meet your needs. This article will provide everything you need to know, making it your one-stop-shop for information regarding Medicare. Read on to learn about your options and find out which plan is best for you.

In this article, we’ll cover:

  1. Original Medicare Plans & Coverage
  2. Medicare Part D, Prescription Drug Plans
  3. Medicare Supplement, or ‘Medigap’
  4. Medicare Advantage

Original Medicare Plans

There are four plans that Medicare offers. They are labeled using letters of the alphabet and include Part A, Part B, Part C, and Part D. Each part covers services for a different aspect of healthcare. Here is a brief overview.

 

PLAN COVERAGE PREMIUM
Part A
  • Inpatient hospital coverage
  • Might have premium
Part B
  • Outpatient care
  • Doctor visits
  • Lab tests
  • Home health services
  • Medical equipment
  • Will have premium +
  • Medicare pays 80%
  • You pay 20% of everything else
  • No cap or maximum
Part C
  • Inpatient hospital coverage
  • Outpatient care
  • Prescription drug coverage
  • Dental*
  • Vision*
  • Hearing*
  • Fitness* 
  • Will have premium
Part D
  • Drug Coverage
  • % deductible varies

* Not all Medicare Part C Plans cover these items.

Part A and B

As you can see in the chart, Medicare parts A and B cover hospitalization and doctor visits. But this still leaves many medical expenses uncovered. It does not cover items such as:

  • Long-term care
  • Dental
  • Vision
  • Dentures
  • Cosmetic Surgery
  • Hearing aides and exams

In addition, it’s important to note that your Part B premium only covers 80% of doctor-related costs. You’ll be required to pay the other 20% for medical necessities such as outpatient treatments, doctor visits, and medical procedures. If a medical emergency arises, you could still be left with thousands of dollars in expenses.

Part D

Medicare Part D provides prescription drug coverage and will come with a separate premium. Without Part D, you would have to pay all prescription drug costs out of pocket. Even if you don’t need prescription drugs now, it’s important to be covered in case you need medications in the future.

Part C or Medicare Advantage Plan

Medicare Part C is known as the Medicare Advantage Plan and bundles Part A, B, and D into one plan. Part C plans are purchased through private insurance companies. Medicare Advantage will include everything in Original Medicare in addition to extras such as vision, dental, hearing, and fitness. Not all Advantage Plans provide the same offerings beyond Original Medicare so be sure to shop around.

Here is a quick look at the differences between Original Medicare and Medicare Advantage Plans.

ORIGINAL MEDICARE MEDICARE ADVANTAGE
Coverage
  • Part A and B
  • Part A, B, D + vision, dental, and hearing*
Maximum Out of Pocket Costs
  • No Maximum on OOP costs
  • Yearly limit on OOP costs. After OOP limit, members pay nothing.
Doctors and Hospitals
  • Any doctor or hospital that accepts Medicare
  • Doctors and hospitals in your plan’s network.
  • Out of network doctors and hospitals may incur higher costs.
Premiums
  • Part A – No premium
  • Part B – Around $135/mo.
  • Part B – Around $135/mo. +
  • MA – plan premiums vary
Deductibles
  • Part A – Around $1,364
  • Part B – Around $185
  • Deductibles and copays vary
Prescription Drug Coverage
  • Must purchase Part D or stand-alone drug coverage
  • Varies by plan
Can You Change Plans?
  • Yes.
  • Switch to Medicare Advantage during the Annual Election Period from Oct 15-Dec 17
  • Yes.
  • Switch Medicare Advantage Plans or to original Medicare during the Annual Election Period from Oct 15-Dec 17

*Not all Medicare Advantage plans cover vision, dental, and hearing.

Medicare Supplement Plans

Known as Medigap, Medicare Supplement plans help cover the gaps in your Original Medicare policy. While there are many supplement plan options, here is a guideline to compare the major differences between Medicare Advantage and Medicare Supplement plans:

MEDICARE ADVANTAGE MEDICARE SUPPLEMENT
Coverage
  • Part A, B, D + vision, dental, and hearing*
  • Does not cover vision, dental, or hearing.
Copayments and Coinsurance coverage
  • Copays and coinsurance fees typically apply.
  • Copays and coinsurance fees may be completely covered.
Doctors and Hospitals
  • Doctors and hospitals in your plan’s network. Out of network doctors and hospitals may incur higher costs.
  • Any doctor or hospital that accepts Medicare
Premiums
  • Monthly – as low as $0
  • Part B – Around $135/mo.
  • Monthly – Varies by plan
  • Part B – Around $135/mo.
Deductibles
  • Varies by plan. May not have deductible.
  • Yes, and varies by plan.
Prescription Drug Coverage
  • Yes. Usually covers prescription drugs.
  • No
Can You Change Plans?
  • Yes. Plans may be changed during open enrollment periods as many years as needed.
  • Only once during your lifetime.

*Not all Medicare Advantage plans cover vision, dental, and hearing.

Which Medicare Option is Right For You?

Now that you know about your plan options, which do you choose? There is a short window to apply without penalty, so you want to be ready. Here is what your decision-making process should look like:

If you are leaning towards an Original Medicare plan, ask yourself the following question, “Should I accept or deny Part D (Prescription Drug Plan) Coverage and should I purchase a Medicare Supplement Plan?” If you are unsure on how to answer that question, head over to Do I Need a Medicare Prescription Drug Plan? and What is Medicare Supplement and Do I Need It?.

If you are leaning towards a Medicare Advantage Plan, you ask yourself, “Do I need any extra coverage for dental?” If you do, it’s important to vet third-party Medicare Advantage providers to find a plan that best suits your needs. If you are unsure, head over to Does Medicare Cover Dental?

Making the Right Choice

Choosing the right Medicare plan is a very personal choice. A Medicare plan that works for one person may not work for another. Take your time to weigh out the pros and cons of each before deciding on a plan that fits your needs. Read back over this article and find someone to talk with. It’s always a good idea to seek advice from someone who has already gone through the enrollment process. This is your future. Make every decision count. Get started by asking for a Medicare quote today.

 

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