Understanding Your Medicare Options

Medicare gives you two main ways to receive your health coverage: Original Medicare and Medicare Advantage. Understanding how each option works—and where prescription drug coverage and Medicare Supplement insurance fit in—can help you choose coverage that meets your needs.

Original Medicare: Parts A and B

Original Medicare includes Part A, which helps cover inpatient hospital care and certain other services, and Part B, which helps cover doctor visits, outpatient care, medical equipment, and preventive services.

You can receive care from any doctor or hospital that accepts Medicare. You can also add a separate Part D prescription drug plan and may purchase Medicare Supplement insurance to help with your share of covered medical costs.

Medicare Advantage: Part C

Medicare Advantage is another way to receive your Medicare benefits through a private insurance company approved by Medicare. These plans provide your Part A and Part B coverage, and most include Part D prescription drug coverage.

Depending on the plan, you may need to use a provider network, obtain referrals, or receive approval before certain services are covered. Plans have an annual limit on your out-of-pocket costs for covered Part A and Part B services. You generally continue paying your Part B premium, along with any premium charged by the plan.

Certain benefits are handled separately. For example, Original Medicare pays for the hospice benefit even if you remain enrolled in a Medicare Advantage plan.

Medicare Supplement Insurance: Medigap

Medicare Supplement insurance, also called Medigap, is private insurance that helps pay some of the costs you would otherwise pay yourself under Original Medicare. Depending on the policy, these may include deductibles, copayments, and coinsurance.

Some policies also provide limited coverage for emergency medical care while traveling outside the United States. Medigap policies sold today do not include prescription drug coverage, so you may want a separate Part D plan.

Medigap works with Original Medicare. It cannot be used to pay your Medicare Advantage plan’s out-of-pocket costs.

Medicare Prescription Drug Coverage: Part D

Part D helps pay for prescription medications. You can get this coverage through a separate drug plan or through a Medicare Advantage plan that includes it. Plan costs and covered medications vary, so compare your prescriptions and preferred pharmacies before choosing coverage.

After your Initial Enrollment Period, a gap of 63 consecutive days or more without Part D or other creditable prescription drug coverage may result in a late-enrollment penalty when you enroll later. Creditable coverage is drug insurance expected to pay, on average, at least as much as Medicare’s standard drug coverage. You do not pay this penalty while receiving Extra Help.

Get Help Comparing Your Options

The right coverage depends on your doctors, prescriptions, budget, and healthcare needs. Contact our office for help understanding your choices and comparing the coverage available in your area.