There are many terms to understand and options to consider when it comes to Original Medicare insurance and Medicare Advantage Plans. Here’s a guide to help you make better sense of it all.
Original Medicare Insurance Explained
Original Medicare is a federal health insurance program that pays for a variety of health care expenses and services such as hospitalizations, physician visits, prescription drugs, preventative services, skilled nursing facility and home health care as well as hospice care. It was created for people ages 65 and over, regardless of income, medical history or health status. It also covers those under age 65 who have a long-term disability.
Medicare Parts and Plans
Medicare Part A (Hospital Insurance)
Medicare Part A covers most inpatient hospitals, skilled nursing homes, home health and hospice care. There is a monthly premium for Part A, but many people will qualify for a premium-free Part A.*
Medicare Part B (Medical Insurance)
Medicare Part B covers routine doctor visits, including specialists to treat your medical conditions. It also covers preventative services, which is meant to prevent illness (like the flu) or to detect at an early stage, when treatment is likely to work best.
Medicare Part C (Medicare Advantage Plans)
Medicare Part C—also known as Medicare Advantage plans—are an alternative to Original Medicare, offering at least the same benefits but can often include additional coverage such as routine vision or routine dental benefits.
Medicare Part D (Prescription Drug Plans)
Medicare Part D, also referred to as Medicare Prescription Drug plans, provides Medicare beneficiaries access to retail prescription drugs at affordable copays. Part D plans are operated by Medicare-approved private insurance companies and are available to everyone who has Original Medicare or a Medicare Advantage Plan. A Medicare Part D plan can be purchased either as a standalone plan to supplement Medicare Parts A and B or to accompany a Medicare Supplement Insurance plan.
Medicare Supplement Plans
Medicare Supplement Insurance plans—also known as Medigap Insurance—help cover the gaps in coverage from Original Medicare. In most states, there are eight Medicare Supplement plans to choose from and all policies have been standardized. Medicare Supplement insurance plans are available through private insurance companies and are denoted by the letter A through N (plans C, E, F, H, I and J are no longer sold).
Additional Medicare Coverage Options
When it comes to coverage for routine dental care, Original Medicare does not offer coverage for annual exams, cleaning, crowns, bridges or dentures. However, you can consider a stand-alone dental plan or explore Medicare Advantage plans, which often include routine benefits not covered by Original Medicare.
When it comes to Original Medicare coverage and vision, Parts A and B also don’t cover routine vision care such as annual exams, eyeglasses or contacts. Medicare Part B can sometimes cover a handful of services related to vision needs like eye exams for diabetic patients, glaucoma tests and macular degeneration tests and treatment. Stand-alone vision insurance options are also available.
Original Medicare also does not cover the cost of hearing exams or hearing aids. If you’re on Medicaid, you may be covered for hearing aids spending on your coverage plan and wear you live. There are also affordable over-the-counter options for seniors with mild hearing loss.
Medicare Enrollment Periods
Each year, there are five set times you can enroll in a Medicare plan or change your existing coverage.
Medicare Initial Enrollment Period (IEP)
The Medicare Initial Enrollment Period begins three months before the month of your 65th birthday and continues through the three months following. This is the first time you can enroll in Medicare Part A and Part B.
Medicare Annual Enrollment Period (AEP)
The Medicare Annual Enrollment Period (AEP) runs from October 15-December 7 each year. Medicare Advantage plan details often change annually, so it’s a good idea to compare your Medicare Advantage plan options during this time each year to make sure your health and prescription drug needs are covered. During this period, Medicare recipients can:
Switch from Original Medicare (Medicare Part A and Medicare Part B) to a Medicare Advantage plan (Medicare Part C).
Change from one Medicare Advantage plan to another Medicare Advantage plan.
Switch from one Prescription Drug plan (Medicare Part D) to another.
Add a Prescription Drug plan if you didn’t enroll when first eligible for Medicare.
Medicare Advantage Open Enrollment Period (OEP)
The Medicare Advantage Open Enrollment Period (OEP) takes place from January 1-March 31 each year. During this period, Medicare Advantage plan participants can make a one-time plan change. This opportunity allows Medicare Advantage enrollees to:
Switch to a different Medicare Advantage Plan
Drop a Medicare Advantage plan and return to Original Medicare (Part A and Part B)
Sign up for a stand-alone Medicare Part D Prescription Drug plan, if electing to return to an Original Medicare plan
Medicare Special Enrollment Period (SEP)
The Medicare Special Enrollment Period (SEP) takes place when certain events or life changes occur, giving Medicare beneficiaries the opportunity to make changes to their existing Medicare Advantage and Medicare Prescription Drug coverage. There are several types of Medicare Special Enrollment Periods with different qualification standards for each. Some of the most common Special Enrollment Period events for Medicare Advantage include:
Moving to a new address that isn’t in your current Medicare plan’s service area
Moving to a new location where new Medicare plan options are available, even though your current Medicare plan also includes coverage for your new address
Returning to the U.S. after living outside the country
Moving in or out of a skilled nursing facility or long-term care hospital
Being released from jail
Medicare General Enrollment Period (GEP)
The Medicare General Enrollment Period runs from January 1-March 31 each year. This period provides an enrollment opportunity for individuals who didn’t sign up for Original Medicare (Part A and Part B) when they were first eligible.
Let SelectQuote help answer your Medicare Advantage questions today.
We specialize in helping consumers understand the ins and outs of Medicare Advantage Plans. We can ensure you’re getting the benefits available to you. And, in just minutes, we can shop and compare Medicare Advantage plans on your behalf.
