You have important decisions to make when you're eligible for Medicare. Be confident in choosing coverage that fits your health care and budget needs.
When considering what Medicare coverage to choose, it's important to first understand what each option provides and who provides each. Then, we will walk through how the different options may work together to help ensure you have all the health coverage you need.
Let's review the following: Original Medicare (Parts A and B), Medicare prescription drug coverage (Part D), Medicare Advantage (Part C) and Medicare supplement insurance (Medigap).
Original Medicare (Parts A and B) is provided by the federal government. Part A helps pay for hospital stays and inpatient care, while Part B helps pay for doctor visits and outpatient care. Everyone who enrolls in Medicare gets Part A and Part B first.
Medicare Part D is prescription drug coverage. Part D coverage can be obtained from private insurance companies in one of two ways: (1) as a stand-alone Part D plan, (2) as part of a Medicare Advantage plan that includes prescription drug coverage. With either choice, the different drugs covered will vary from plan to plan.
Medicare Advantage, or Part C is an alternative way to get Part A and Part B coverage benefits. Medicare Advantage plans are "all in one" plans that are offered by private insurance companies. With Medicare Advantage plans, you still enroll in Part A and Part B through the federal government, but then you will enroll in a Part C plan with a private insurance company. Once you do that, you will get your Part A and Part B benefits through your Medicare Advantage plan. Most Medicare Advantage plans also include Part D prescription drug coverage, as well as other benefits such dental, vision, hearing and fitness. There are different types of Medicare Advantage plans, and what additional benefits are provided vary from plan to plan.
Medicare supplement insurance plans, also known as Medigap, helps pay some of the out-of-pocket costs not paid by Original Medicare (Parts A and B). There are 10 plans, organized by letters (ex. Plan A) and standardized by the federal government.* However, it’s important to note that Medigap plans are only available to purchase directly from private insurance companies. Each Medigap plan offers the same basic benefits no matter which insurance company sells it, but costs may vary.
*Note: In Massachusetts, Minnesota and Wisconsin, there are different plan options available.
Answer a few simple questions and get a personalized list of plans, ranked by what's important to you.
Now that we have looked at the different coverage options, let's see how some of them can be combined to provide you with more complete health care coverage. Original Medicare, Part D and Medigap can work together. Medicare Advantage and Part D can also work together in certain situations. Medicare Advantage and Medigap cannot work together. In total, there are seven different Medicare coverage combinations.
If you get Original Medicare (Parts A and B) you can choose to have only Part A and Part B, or you can add a stand-alone Part D plan, a Medicare supplement insurance (Medigap) plan or both.
Original Medicare (Part A and Part B)
PLUS a standalone prescription drug plan (Part D)
AND a Medicare supplement (Medigap) plan
If you choose to get your Part A and Part B benefits through a Medicare Advantage (Part C) plan, you may or may not need additional coverage. Most Medicare Advantage plans already come with built-in Part D prescription drug coverage, but some do not. You can add a stand-alone Part D plan to the following types of Medicare Advantage plans: Private-Fee-For-Service (PFFS) Medicare Advantage plan or a Medicare Medical Savings Account (MSA) plan.
Medicare Advantage Private Fee-for-Service plan without drug coverage (Part C) OR a Medicare Savings Account (MSA) plan PLUS a stand-alone prescription drug plan (Part D)
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ONSCREEN TEXT: How to Choose the Right Medicare Plan NARRATOR: How to choose the right Medicare plan for you. Four illustrated hands raise in the air. ONSCREEN TEXT: Medicare coverage should fit your unique health and lifestyle needs NARRATOR: Medicare coverage should fit your unique health and lifestyle needs. The answers to a few important questions can help you determine which Medicare coverage option is right for you. Let’s get started. A bottle of pills appears. ONSCREEN TEXT: Do you take prescription drugs? NARRATOR: Do you take prescription drugs? The word “Yes” appears beside an icon of a pill bottle labeled “Part D” and an icon of a bed and stethoscope labeled “Medicare Advantage”. NARRATOR: If you answered yes, you will want to consider a Part D prescription drug plan, or Medicare Advantage plan with built in prescription drug coverage. Text appears beside a graphic of a coin rising out of a wallet. ONSCREEN TEXT:
No Watch out for Part D late enrollment penalty NARRATOR: If you answered no, just be aware that you could face a Part D late enrollment penalty if you choose to enroll later on and don’t have creditable drug coverage. Text appears above a toothbrush, a person’s ear, an eye chart, and a shelf holding a plant. ONSCREEN TEXT: Do you want coverage for dental, vision, or hearing care? NARRATOR: Do you want coverage for dental, vision, or hearing care?
The word “Yes” appears above the Medicare Advantage icon. NARRATOR: If you answered yes, a Medicare Advantage plan may be a good fit. The word “No” replaces “Yes”. NARRATOR: If you answered no, you don’t need to consider these when choosing your coverage. A stethoscope appears. ONSCREEN TEXT: Do you visit the doctor often? NARRATOR: Do you visit the doctor often? Frequent doctor visits can get costly. Your cost may include plan deductibles, co-pays, co-insurance, and other out of pocket costs. Three progressively larger dollar signs appear. Text appears, followed by three progressively taller vertical bars. The tallest bar is composed of horizontal bars, and is topped by a dollar sign. ONSCREEN TEXT:
Tip: Estimate your healthcare costs 20% You 80% Medicare NARRATOR: It’s a good idea to estimate what your total cost for the year may be if you see a doctor, or other specialist, frequently. An icon of a credit card appears. ONSCREEN TEXT: Is paying for Medicare a concern? NARRATOR: Is paying for Medicare a concern? If yes, there are a variety of financial assistance programs available that could help. Text appears. ONSCREEN TEXT: Medicare financial assistance programs · Medicaid · Medicare Savings Programs · Extra Help · PACE · State-specific financial aid programs NARRATOR: Consider seeing if you qualify for Medicaid, a Medicare savings program, extra help, or programs of all-inclusive car for the elderly known as PACE programs. Your state may also have specific financial aid programs available, that you can try as well. Blue text appears against a white background. ONSCREEN TEXT: Medicare Made Clear brought to you by UnitedHealthcare
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