Navigating the Different Types of Medicare Plans

Original Medicare: The Foundation of Your Coverage

Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance). Part A helps cover inpatient care in hospitals, skilled nursing facility care, hospice, and some home health care. Part B covers medically necessary services from doctors and other healthcare providers, as well as outpatient care, durable medical equipment, and many preventive services. When you have Original Medicare, you can go to any doctor or hospital in the U.S. that accepts Medicare, and the government pays a portion of the costs for covered services.

How to Fill the Gaps in Original Medicare

Original Medicare (Part A and Part B) provides a solid foundation of coverage for hospital stays and medical services, but it doesn’t cover everything and can leave you with out-of-pocket costs. Coverage gaps can include deductibles, coinsurance, and copayments, as well as a lack of an annual out-of-pocket maximum, meaning there is no limit to how much a beneficiary could pay in a year.
Supplemental Medicare coverage can help to fill these gaps. Medicare Advantage (Part C) plans, offered by private companies, are an alternative to Original Medicare but may include additional routine benefits. Medicare Supplement plans (Medigap) are separate policies that work alongside Original Medicare to help pay for out-of-pocket costs like deductibles, coinsurance, and copayments. For beneficiaries concerned about prescription costs, Medicare Part D plans are stand-alone prescription drug plans that can be added to Original Medicare to help cover the cost of medications.

Getting Prescription Drug Coverage (Part D)

Prescription medications you take at home are not typically covered by Original Medicare. If you want prescription drug coverage, you have two options:

1. Enroll in a stand-alone Medicare Part D plan (Prescription Drug plan) that works alongside Original Medicare

2. Choose a Medicare Advantage plan that also includes prescription drug coverage

As you consider a Medicare Prescription Drug plan, pay attention to the formulary—a list of covered prescription drugs. If you are already taking prescription medications, be sure to check that your prescription is covered before you sign up for a plan. Medicare Part D plans may include both brand-name and generic prescription drugs. Part D plans generally need to include at least two drugs in the most commonly prescribed categories and classes, but plans can choose which drugs are covered and which ones aren’t.

In terms of monthly costs, most Medicare Prescription Drug plans charge a monthly premium. You’ll need to pay this in addition to the Medicare Part B premium. If you join a Medicare Advantage plan (Part C) that includes Medicare prescription drug coverage, the plan’s monthly premium may include an amount for drug coverage. Deductibles vary between Part D plans, and Medicare prescription drug plans may also have a copayment or coinsurance.

Comparing Medicare Plans to Find Your Right Fit

Comparing Medicare plans will help you decide what type of coverage will suit your healthcare needs. Read on to compare the differences between Original Medicare and Medicare Advantage plans.

Medicare Plans Comparison Chart by Coverage Type

Medicare Plans Comparison Chart by Coverage Cost

Medicare plans, like Original Medicare plans and Medicare Advantage plans, vary in their coverage and costs. Medicare costs often differ by income, work qualifications, and the amount of coverage needed. It’s important to note that Medicare Advantage plans typically have less out-of-pocket costs compared to Original Medicare plans.