Medicare coverage5 Important points about Medicare Part A and B coverage gaps
Medicare is designed to reduce some of the financial strain of paying for healthcare in your later years. Making the most of your coverage begins with choosing the right plan.
The benefits and costs associated with the different Medicare options can vary greatly. Asking yourself these 10 questions may help you determine which option is likely to work best for you.
Original Medicare refers to Medicare Parts A and B. Part A covers the cost of hospital-related care, including inpatient services, lab tests and surgery. Part B is the medical insurance component of Medicare, which covers doctor visits, outpatient care and certain preventive services. Both Part A and Part B are administered by the federal government.
2. Will I pay a premium for Part A or Part B?
For most people, Part A coverage is premium-free as long as you or your spouse paid Medicare taxes for at least 10 years while you were working. There's also no premium for Part A if you're receiving Social Security or Railroad Retirement Board (RRB) benefits at the time you enroll.
Part B coverage requires a monthly premium, which is deducted from your Social Security or RRB benefits if you're receiving them. For 2019, the standard premium for Part B coverage is $135.50, but your premium may be higher based on your tax filing status and modified adjusted gross income.
3. Are there any other costs for Original Medicare?
In addition to premiums, you’re also responsible for paying a deductible and coinsurance with Original Medicare. The 2019 deductible for inpatient hospital stays is $1,364 per benefit period. The annual deductible for Part B is $185. Coinsurance is typically 20% of the Medicare-approved amount for most services.
4. What is a Medicare Advantage plan?
Medicare Advantage plans are offered by private insurance companies—like Humana—contracted by the federal government. Medicare Advantage, also referred to as Medicare Part C, covers the same healthcare services as Original Medicare, with the exception of hospice care. Many Medicare Advantage plans also include prescription drug coverage.
In addition, most Medicare Advantage plans include coverage for vision, dental and hearing care. Health and wellness plans like SilverSneakers® may be included, as well.
5. How much does Medicare Advantage cost?
With Medicare Advantage plans, instead of paying your healthcare bills directly, the federal government pays private insurance companies—like Humana—to administer your coverage.
While there is a monthly premium for Medicare Advantage plans, many private insurance companies choose to offer low or $0 premiums to compete for your business. They also set the guidelines for your deductible, coinsurance and copays. This information is readily available on private insurers’ websites, or you can work directly with a licensed Humana sales agent to learn the details and purchase a Medicare Advantage plan.
As with Original Medicare members, Medicare Advantage members must continue to pay their Part B premium.
6. Are prescription drugs covered by Medicare?
There are 2 ways to get Medicare prescription drug coverage:
- You can choose a Medicare Advantage plan that includes prescription drug coverage (these are called MAPD plans)
- You can purchase a stand-alone prescription drug plan—called Part D—to add to your Original Medicare
Your out-of-pocket costs for prescription drug deductibles, copays and coinsurance vary from plan to plan. Be sure to check each plan’s Drug List to see what drugs are covered.
7. What is supplemental Medicare coverage?
Medicare Supplement insurance, often called “Medigap coverage,” helps fill the cracks in coverage for those with Original Medicare. Medigap plans are sold by private insurers to help cover things like your deductibles, coinsurance and copays.
You'll pay a monthly premium for a Medicare Supplement plan in addition to your Part B premiums. Medicare Supplement plans are not available with Medicare Advantage plans.
8. Can I get Medicare with a preexisting condition?
Yes, even with a preexisting condition, you can enroll in Original Medicare or a Medicare Advantage plan.
Note: With Medicare Advantage, you can't enroll in a plan if you have end-stage kidney disease. And with Medicare Supplement plans, if you don’t sign up when you first become eligible, the insurer may impose a waiting period before your coverage takes effect for any preexisting issues.
9. Will I be able to choose my doctor?
With Original Medicare, a primary care doctor is not required. You can visit any doctor who accepts Medicare.
With a Medicare Advantage plan, your choice of doctor depends on whether you select a health maintenance organization (HMO) or preferred provider organization (PPO) plan.
With an HMO plan, you can choose your primary care physician from any doctor in the plan's network. If you opt for a PPO plan, choosing a primary care doctor is optional. With both types of plans, you’ll save money by using an in network provider.
It’s important to note that Medicare Advantage plans must offer emergency coverage outside of the plan’s service area anywhere in the U.S.
10. Do all doctors and healthcare facilities accept Medicare?
Medicare is widely accepted, but it’s not universal. When reviewing plan options, pay close attention to which providers in your area accept Medicare to ensure that you have access to care when you need it.
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