What to look for when comparing Medicare plans

Understanding what Medicare covers—and what it doesn’t—is the first step toward choosing the coverage options that best meet your particular needs. The following information can help you compare your Medicare options so you can choose your plan with confidence.

Compare types of Medicare coverage

Original Medicare

Medicare Part A – hospital coverage

What it covers:

  • Hospital care
  • Skilled nursing facility care
  • Nursing home care (as long as that isn't the only care you need)
  • Hospice care
  • Home healthcare

What it costs:

Most people don't pay a monthly premium for Medicare Part A, if they worked and paid Medicare taxes. However, there are costs you may have to deal with.

Other Part A costs:1

  • There is an annual deductible of $1,364 for inpatient hospital stays.
  • There is a $341 per day coinsurance payment for inpatient hospital stays for days 61 to 90.
    • After day 91, there is a $682 daily coinsurance payment for each lifetime reserve day used.
    • After the maximum 60 lifetime reserve days are exhausted, there is no more coverage under Part A for inpatient hospital stays.
  • There is a 20% copay for Medicare-approved durable medical equipment (DME).
  • Medicare does not cover any room and board costs for hospice care in your home or in a nursing home if that is where you live.
  • There is a $170.50 coinsurance payment for days 21 to 100 for a skilled nursing facility stay.
    • After day 100, you are responsible for all costs.
  • There is a 20% copay for mental health services connected with a hospital stay.

Medicare Part B – medical coverage

What it covers:

  • Medically necessary doctor services
  • Outpatient care
  • Chiropractic care
  • Home health services
  • DME
  • Many preventive services

What it costs:2

  • Most Medicare and Medicare Advantage 2019 plan members must pay a monthly premium of $135.50.
  • If you don't enroll in Medicare Part B as soon as you are eligible, you could be assessed a late enrollment penalty when you do enroll.
    • The penalty could be as high as a 10% increase in your premium for each 12-month period that you were eligible but not enrolled.
  • If you earn over $85,000 ($170,000 for joint filers), you’ll pay a higher monthly premium for Part B.

Other Part B costs:

  • There is a $185 annual deductible for Medicare Part B in 2019.
    • After the deductible, you’ll pay a 20% copay for most doctor services while hospitalized, as well as for DME and outpatient therapy.
  • There is a 20% copay of the Medicare-approved amount for doctor visits to diagnose a mental health condition after the deductible.
    • If you receive these services at a hospital outpatient department or clinic, additional copays or coinsurance amounts may apply.
  • There is a 20% copay of the Medicare-approved amount for outpatient services, after the deductible.

Medicare Advantage

What it covers:

  • Medicare Advantage plans are required by law to provide—at minimum—the same coverage, benefits and rights provided by Original Medicare Part A and Part B, with the exception of hospice care.
  • Many Medicare Advantage plans also offer:
    • Prescription drug coverage
    • Dental, vision and hearing benefits

What it costs:

  • Plans vary in cost, coverage, deductibles and copays.
  • Many Medicare Advantage plans offer affordable or $0 dollar premiums plus a variety of additional benefits over Original Medicare.

Medicare Advantage plans include:

  • Health maintenance organization (HMO) plans
  • Preferred provider organization (PPO) plans
  • HMO point of service (HMO POS) plans
  • Private-fee-for-service (PFFS) plans
  • Special Needs Plans (SNPs)

See costs and coverage for Humana Medicare Advantage plans

Medicare Part D

What it covers:

  • Medicare Part D covers prescriptions drugs.

What it costs:

  • Premiums, covered drugs, deductibles, coinsurance and copays will vary by plan.
  • There’s a late enrollment penalty if you don’t enroll in an approved Medicare drug plan (including a Medicare Advantage plan) when you’re first eligible or have other credible prescription drug coverage.
    • The penalty for 2019 is the “national base premium” of $33.19 per month.
  • If you earn over $85,000 ($170,000 for joint filers), you’ll pay a higher monthly premium.

See costs and coverage for Humana prescription drug plans

Medicare Supplement plans

What it covers:

  • Offered by private companies, Medicare Supplement insurance plans help offset some Original Medicare out-of-pocket costs.
  • These plans can only be paired with Original Medicare; they cannot be added to a Medicare Advantage plan.

What it costs:

See costs and coverage for Humana Medicare Supplement insurance plans

Sources

  1. “Medicare Costs at a Glance,” Medicare.gov, last accessed September 23, 2019, https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance, opens new window.
  2. “Medicare Costs at a Glance.”

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