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If you are aging into Medicare, or are already on a Medicare plan, you have important decisions to make. Choosing the best plan for your situation is critical. And not acting at the prescribed time can cause a penalty.
Below are two charts we put together to help you navigate the Medicare forest. Original Medicare vs Medicare Advantage vs Medicare Supplement compares the major differences between your three options. Medicare Basics at a Glance gives you key dates, choices and how to enroll.
Navigating Medicare may look bewildering but it doesn’t have to be. Insureous agents can guide you through all the steps to enroll or change plans.
Original Medicare vs Medicare Advantage vs Medicare Supplement
| | Original Medicare | Medicare Advantage | Medicare Supplement |
| Doctor and hospital choice | You can go to any doctor or hospital that takes Medicare, anywhere in the US. In most cases, you don’t need a referral to see a specialist. | In many cases, you can only use doctors and other providers who are in the plan’s network and service area (for non-emergency care). | Gives you access to all providers who accept Medicare. |
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| Cost | For Part B covered services, you usually pay 20% of the Medicare approved amount after you meet your deductible. This amount is called your coinsurance. | Out of pocket cost vary; plans may have lower or higher out of pocket costs for certain services. | Helps pay some of the remaining house care costs for covered services and supplies not covered by original Medicare base and clewed copayments coinsurance and deductibles. |
| Premiums | You pay a monthly premium for Part B. If you choose to join a Medicare drug plan, you’ll pay separate premium for your Part D plan. | You pay a monthly Part B premium, and you may also have to pay the plan’s premium. Some plans offer a zero premium, and they help pay all or part of your Part B premium. Most plans include Medicare Part D drug coverage. | You must pay you’re Part B as well as a monthly premium to the carrier which is typically higher than a Medicare Advantage plan premium. |
| Coverage | Original Medicare covers most medically necessary services and supplies in hospitals, doctors’ offices, and other health care facilities. Original Medicare doesn’t cover some benefits like eye exams, most dental care and routine exams. | Plans must cover all medically necessary services that original Medicare covers. Plans may also offer some extra benefits that original Medicare doesn’t cover like vision, hearing, and dental services. | Coverage is the same as original Medicare, plus deductibles, coinsurance and copayments. All plans offer an additional 365 days in hospital. Some plans offer extras like excess charges, foreign travel and Silver Sneakers program. |
| Foreign travel | Original Medicare generally doesn’t cover medical care outside the US. | Plans generally don’t cover medical care outside the US. Some plans may offer a supplemental benefit that covers emergency and urgently needed services while traveling outside the US. | Medigap plans will cover emergency medical fees when you’re traveling outside the US. |
Medicare Basics at a Glance
| Medicare Key Dates | Oct. 1: Start comparing your current coverage options. It’s important to review your Medicare coverage to see if it still meets your needs. You don’t need to sign up for Medicare each year, but you should still review your options. |
| Oct. 15-Dec. 7: Change your Medicare health or drug coverage . You can join, switch or drop a Medicare Advantage plan or Medicare drug plan during this open enrollment period. | |
| Jan 1 – Mar 31: You can change to a different Medicare Advantage plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time. Any changes will be effective the first of the month after the plan gets your request. | |
| Medicare A, B, C and Ds | Part A = hospital insurance helps cover inpatient care in a hospital, inpatient care in a skilled nursing facility, hospice care, home health care and inpatient care in a religious non-medical health care institution. Part B = medical insurance covers medically necessary doctor’s services, outpatient care, home health services, durable medical equipment, mental health services and other medical services. Part C = Medicare Advantage plans are another way to get your Part A and Part B coverage. Most Advantage plans include drug coverage (Part D). Medicare Advantage plans come in multiple flavors: Health Maintenance Organization (HMO) plansHMO Point-of-Service (HMOPOSS) plans which may allow you to get some services out of network Preferred Provider Organization (PPO) plans which allow you to use out-of-network providers for covered services, usually at a higher cost.Private Fee-for-Service plans Special Needs Plan (SNP) which provides benefits and services to people with specific diseases, have certain health care needs or who also have Medicaid coverage. Part D = prescription drug insurance pays for drugs you may need. It’s optional and offered to everyone with Medicare. Even if you don’t take prescription drugs now, you should consider getting Medicare drug coverage. If you decide not to get it when you’re first eligible, and don’t have other creditable coverage, you’ll likely pay a late enrollment penalty if you join a plan later. |
| Initial enrollment period | You can first sign up for part A and or Part D during the 7-month period that begins three months before the month you turn 65, including the month you turn 65 and ends three months after the month you turn 65. |
| How to sign up | If you’re close to 65 but not getting Social Security or railroad retirement board benefits, you’ll need to sign up for Medicare. You can also contact Social Security three months before you turn 65 to set up an appointment. If you don’t sign up for Part B when you’re first eligible you may have a delay in getting Medicare Part B coverage in the future and you may have to pay a late enrollment penalty for as long as you have a Part D plan. |
| Choosing plans | There are three basic choices you must make: Original Medicare (Part A and Part B) Medicare Advantage (also called Part C) Medicare Supplement (Medigap) |
| Original Medicare | Original Medicare includes Medicare Part A hospital insurance and Part B medical insurance. Original Medicare provides good health insurance, but it only pays about 80 percent of approved costs for doctors, hospitals and medical procedures. Original Medicare usually doesn’t include a prescription drug plan which you will need to buy separately. It also does not include routine dental care. You can join a separate Medicare drug plan to get Medicare drug coverage. Medicare Part D prescription drug coverage is optional if you don’t get it either as a standalone plan or part of a Medicare Advantage plan you may pay a financial penalty if you buy a policy later. |
| Medicare Advantage | Medicare Advantage also known as part C is a Medicare approved plan from a private company that offers an alternative to original Medicare. These bundled plans include Part A, Part B and usually Part D. In most cases you can only use doctors who are in the plan’s network, and you may need to get approval from your plan before it covers certain drugs or services. Plans may have lower out of pocket costs than original Medicare plans may offer and may include extra benefits that original Medicare doesn’t cover like vision hearing and dental services. |
| Medicare Supplement | Before you can buy Medicare supplement insurance you must have Part A and Part B. Medicare Supplement insurance, known as Medigap policies, are sold by private companies and are designed to fill Medicare Part A and Part B coverage gaps. They can help pay some of the remaining health care costs that original Medicare doesn’t cover for services and supplies like copayments, coinsurance and deductibles. Some Medigap policies also offer coverage for services that original Medicare doesn’t cover, like medical care when you travel outside the US. Medigap doesn’t cover long term car, vision or dental services, hearing aids, eyeglasses or private duty nursing. It’s important to compare Medigap policies since the cost can vary between plans offered by different companies for the same coverage and premiums may go up as you get older. The best time to buy a Medigap policy is during your Medigap open enrollment. This six-month period begins the first month you have Medicare Part B medical insurance, and you are 65 or older. After this enrollment period you may not be able to buy Medigap or it may cost more. |
Sources:
- Understanding Medicare Advantage Plans., https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage-Plans.pdf.
- 15 Ways To Be A Smarter Healthcare Patient, https://www.insureous.com/15-ways-to-be-a-smarter-healthcare-patient/.
- How do Medicare Advantage Plans work? | Medicare, https://www.medicare.gov/sign-upchange-plans/types-of-medicare-health-plans/medicare-advantage-plans/how-do-medicare-advantage-plans-work.
- Medicare Advantage vs Medigap | Medigap Plans, https://centurymedicare.com/are-medigap-and-medicare-supplement-the-same/.
- When can I buy Medigap? | Medicare, https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap.
- Compare Original Medicare & Medicare Advantage | Medicare, https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/your-coverage-options/compare-original-medicare-medicare-advantage.
