Coverage outside Parts A and B of Medicare

 

An elderly man flips through a Humana brochure while talking to a Humana agent.
As you approach your 65th birthday, you may feel overwhelmed by complicated choices and terminology you've been hearing about your Medicare coverage. This list will help you sort out Medicare Supplement insurance plans from Medicare Advantage, Part A from Part B (and Part C from Part D).

Original Medicare

Original (traditional) Medicare is comprised of 3 main parts:

  • Part A helps cover inpatient hospital stays, skilled nursing facility stays, some home health visits, and hospice care.1
  • Part B helps cover doctor’s visits and other outpatient visits, and preventive services.2
  • Part D is the prescription drug plan purchased through a private insurance company approved by Medicare.3

If you feel your out-of-pocket costs including monthly premiums, copayments, and co-insurance are too high, you could pay for supplemental, or “Medicare Supplement,” insurance to help cover them.4 It’s also important to note that Original Medicare doesn't cover a lot of things that people may regard as vital to their health and well-being, such as routine eye exams, hearing aids or even prescription drugs.

Medicare Advantage

Your other option besides Original Medicare is a Medicare Advantage plan, sometimes referred to as Medicare Part C.

Here are some of the main differences between Original Medicare and Medicare Advantage plans:

  • Medicare Advantage plans often cover a variety of services to help keep you healthy and not just treat you when you're sick. They may include routine vision and dental care, hearing aids and wellness services.5
  • You can’t buy Medicare Supplement insurance if you're in a Medicare Advantage plan. It’s illegal for anyone to sell you a Medicare Supplement plan if you have Medicare Advantage unless the Medicare Advantage plan coverage is ending. 6
  • Some Medicare Advantage plans don't charge anything for premiums, although they may still have copayments or co-insurance. If you pay a premium for Parts A and B you would still need to do so.
  • Medicare Advantage plans are required to cap the amount of money that members pay out-of-pocket each year. This amount may differ between plans and may change from year to year.7
  • You may not be able to just go to any doctor, hospital or medical supplier. Medicare Advantage plans enter into contracts with such healthcare providers, and with many plans if you go out of your plan's network, you might have to pay a bigger share of the services of the entire cost out of pocket. So before you sign up for a plan, you should make sure that the doctors and hospital you prefer are in its network.8
  • You might have to get a referral from your primary care doctor if you want to see a specialist.9

Decisions, decisions

Whether you choose Original Medicare or a Medicare Advantage plan, it’s important to remember that your decision is not carved in stone. At least once a year, during the Medicare Advantage and prescription drug plan Annual Enrollment Period (October 15 – December 7), you can switch between Original Medicare and a Medicare Advantage plan.10

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