Medicare Simplified — Understanding Your Medicare Coverage Options
Understanding Your Medicare Coverage Options
Medicare is a federal health insurance program designed primarily for individuals age 65 and older. It also provides coverage for certain individuals under age 65 who qualify because of a disability or specific medical conditions.
Understanding Medicare does not have to be complicated. At My Health Insurance Spot, our goal is to help you understand your options so you can make informed decisions about your healthcare coverage.
Understanding the Four Parts of Medicare
Medicare Part A — Hospital Insurance
Part A helps cover inpatient hospital care, skilled nursing facility care under qualifying conditions, hospice services, and certain home healthcare services.
Most people qualify for premium-free Part A because they or their spouse worked and paid Medicare taxes for a sufficient period, generally at least 10 years.
Medicare Part B — Medical Insurance
Part B helps cover medically necessary services such as doctor visits, outpatient care, durable medical equipment, diagnostic testing, and preventive services.
Part B generally pays 80% of the Medicare-approved amount for covered services after the annual deductible is met. You are typically responsible for the remaining 20%, although some services have different cost-sharing rules.
Most beneficiaries pay a monthly Part B premium, which may be higher depending on their income.
Medicare Part C — Medicare Advantage
Medicare Advantage plans are offered by private insurance companies approved by Medicare.
These plans provide your Medicare Part A and Part B benefits through the plan rather than through Original Medicare. Most Medicare Advantage plans also include Part D prescription drug coverage.
Depending on the plan and service area, additional benefits may include routine dental, vision, hearing, or other services not generally covered by Original Medicare.
Medicare Advantage plans may have provider networks, referral requirements, and different out-of-pocket costs. You must generally continue paying your Medicare Part B premium.
Medicare Part D — Prescription Drug Coverage
Medicare Part D helps cover the cost of eligible prescription medications.
Part D coverage is offered through Medicare-approved private insurance companies. You can obtain this coverage through a standalone Prescription Drug Plan when you have Original Medicare or through many Medicare Advantage plans that include prescription drug benefits.
Covered medications, pharmacy networks, and costs vary by plan.
What Is Original Medicare?
Original Medicare consists of:
- Part A: Hospital Insurance
- Part B: Medical Insurance
Original Medicare is administered by the federal government. You may generally receive covered services from any doctor or hospital in the United States that accepts Medicare.
However, Original Medicare does not cover every healthcare expense. It generally does not have an annual limit on your out-of-pocket costs for covered Part A and Part B services.
This is one reason many beneficiaries consider additional coverage.
What Is Medicare Supplement (Medigap) Insurance?
Medicare Supplement Insurance, commonly called Medigap, is offered by private insurance companies to help pay certain out-of-pocket expenses associated with Original Medicare.
Depending on the policy, Medigap may help cover expenses such as deductibles, copayments, and coinsurance.
Medigap policies work alongside Original Medicare. They do not replace Medicare Parts A and B and generally do not include outpatient prescription drug coverage.
Eligibility, enrollment rights, premiums, and plan availability may vary.
Your Two Main Medicare Coverage Options
When choosing how to receive your Medicare benefits, you generally have two main options.
Option 1 — Original Medicare
You receive your hospital and medical coverage through Medicare Parts A and B.
You may also choose to purchase:
- A standalone Medicare Part D Prescription Drug Plan.
- A Medicare Supplement (Medigap) policy to help with certain out-of-pocket expenses.
Option 2 — Medicare Advantage (Part C)
You receive your Medicare Part A and Part B benefits through a Medicare-approved private insurance plan.
Most Medicare Advantage plans include prescription drug coverage and may offer additional benefits.
Plan benefits, provider networks, premiums, and out-of-pocket costs vary by plan and location.
You cannot use a Medigap policy to pay Medicare Advantage plan expenses.
We're Here to Help You Understand Medicare
Choosing Medicare coverage is an important decision. Your healthcare needs, prescription medications, preferred doctors, financial considerations, and available plans can all influence which option may be appropriate for you.
At My Health Insurance Spot, our licensed insurance professionals can help explain Medicare coverage options, answer your questions, and assist you in reviewing plans available in your area.
Personal Service. Professional Guidance. Your Peace of Mind.
My Health Insurance Spot is a brand of The Insurance Spot, Inc., a Florida-licensed insurance agency. We are not affiliated with or endorsed by the U.S. government or the federal Medicare program.