The ABC&D of Medicare

Most Americans will qualify for Medicare when they turn age 65. Parts A&B are provided by the US Federal Government. Parts C&D are private health plans offered by insurance companies. Below is a short description of each. For a more detailed explanation, click here to download the Medicare and you book.

PartWhat it CoversNotes
AHospitals
Nursing Facility
Hospice
Home Health
If you or your spouse paid into Medicare
for at least 10 Years, Part A is provided
at no cost to you. Part A has an annual
deductible for each service and days of use.
BDoctors
Outpatient
Medical Equipment
Part B has a Monthly Premium. Most
Americans will pay $164.90 per month
for Part B in 2023. High income members
may pay more. Part B requires that you pay
a $226 annual deductible and 20% for services.
CCombines
A,B & D
into one easy to use plan.
Also know as a Medicare Advantage Plan (MA).
Medicare Advantage plans can include Part D (MAPD).
MA and MAPD plans Cost as little as $0/month.
Many include Dental, Vision, and Hearing benefits.
DPrescription DrugsPart D Plans cover your prescription costs with an additional monthly premium. Most have co-pays and deductibles.

In addition to the 4 parts above Private insurance companies offer Supplement Plans (Medi-Gap). Supplements are regulated by the Center for Medicare & Medicaid Services and are the same coverage across all private insurance companies. Supplements are know by a letter like F,N,G. The purpose of a supplement is to pay for expenses that Part A and B do not pay for.

When you enroll in medicare you will have the ability to purchase a Medicare Advantage plan or a supplement with Part D.

Medigap and Medicare Advantage plans are two different options for enhancing your Medicare coverage. They serve distinct purposes and have their own set of advantages and disadvantages. Here’s a comparison of the two:

Medigap (Medicare Supplement Insurance):

  1. Supplemental Coverage: Medigap plans are designed to work alongside Original Medicare (Part A and Part B) to cover the out-of-pocket costs that Medicare doesn’t pay, such as deductibles, copayments, and coinsurance.
  2. Provider Choice: With Medigap, you have the freedom to see any healthcare provider that accepts Medicare, as long as they accept new Medicare patients.
  3. No Network Restrictions: There are no network restrictions or referrals required to see specialists. You can go to any doctor or hospital that accepts Medicare.
  4. Standardized Plans: Medigap plans are standardized by the government, meaning the coverage options are consistent across different insurance companies. There are several standardized plan types, such as Plan A, Plan B, etc., and the benefits are the same regardless of the insurer.
  5. Monthly Premiums: You will typically pay a monthly premium for your Medigap plan, in addition to your Medicare Part B premium.
  6. No Prescription Drug Coverage: Medigap plans do not include prescription drug coverage. You would need to enroll in a standalone Medicare Part D plan for prescription drug coverage.
  7. Click this link to see a side by side comparison of Medigap plans.

Medicare Advantage (Part C) Plans:

  1. Bundled Coverage: Medicare Advantage plans are private insurance plans that provide an alternative to Original Medicare. They typically combine hospital (Part A) and medical (Part B) coverage into a single plan.
  2. Additional Benefits: Many Medicare Advantage plans offer extra benefits not provided by Original Medicare, such as prescription drug coverage, dental, vision, hearing, and wellness programs.
  3. Network Restrictions: Medicare Advantage plans often have networks of doctors and hospitals. You may be required to use healthcare providers within the plan’s network, except in emergencies.
  4. Referrals and Prior Authorization: Some Medicare Advantage plans require referrals to see specialists or prior authorization for certain treatments or procedures.
  5. Monthly Premiums: While some Medicare Advantage plans have $0 premium options, others may charge a monthly premium in addition to your Medicare Part B premium.
  6. Annual Changes: Medicare Advantage plans can change their benefits and costs annually, so it’s essential to review your plan during the annual enrollment period and consider switching if necessary.
  7. Geographic Variability: Plan availability and options can vary by location, so the choices may be limited in certain areas.

In summary, the choice between Medigap and Medicare Advantage depends on your specific healthcare needs, budget, and preferences. Medigap plans provide more flexibility in terms of healthcare providers and have standardized coverage, while Medicare Advantage plans offer bundled coverage with extra benefits but may have network restrictions and annual changes. It’s crucial to carefully evaluate both options and select the one that aligns with your individual healthcare requirements.