Medicare is a federal health insurance program for individuals 65 and older, and some younger people with disabilities. We're here to help you understand the basics of Medicare and help make sure you get the coverage you need to keep you and your budget as healthy as possible.
There are four parts to Medicare (A, B, C, and D), and each covers a different health care service.
This helps cover inpatient hospital stays, skilled nursing facility care, home health care and hospice care. Part A coverage is free for most people.
This helps cover services from doctors and other health care providers. It also helps cover outpatient care, medical supplies and durable medical equipment (like wheelchairs and oxygen tanks). Most people pay a monthly premium for Part B and it covers 80% of these services. You will pay the remaining 20%.
This is an alternative offered by private insurance companies. It combines the coverage of Part A and Part B, and often includes additional benefits like vision or dental coverage. Most Medicare Advantage plans also include Part D Prescription Drugs.
This covers prescription drug medication and vaccines.
Original Medicare doesn't cover all services, and members generally pay deductibles, and 20% coinsurance for most services with no yearly cap on out-of-pocket expenses. It also does not include prescription drug coverages. Once you enroll in Original Medicare, you can choose to add plan(s) from private insurance companies to help fill some of the coverage gaps and reduce your out-of-pocket costs.
Important Note: If you sign up for additional plans, you must continue to pay any Part A or Part B monthly premiums.
1. Continue to get your Parts A and B coverage through Original Medicare and add a standalone Part D Prescription Drug plan and/or a Medicare supplement (Medigap) plan.
2. Get your Parts A and B coverage through a Medicare Advantage (Part C) plan. These plans cover all Part A and Part B services and often include additional benefits like prescription drugs, dental, vision, etc.
You will receive your Part A (hospital) and Part B (medical) coverage.
Most people will pay no premium for Part A, but will pay a monthly premium for Part B. You will also pay 20% coinsurance for medical services, and have no annual out-of-pocket maximum.
With Original Medicare, you can see any provider who accepts Medicare payment.
Important NoteIf you choose the Original Medicare path, you’ll need to be enrolled in several different plans to make sure you get the coverage you need for drugs, dental and vision, and other out-of-pocket costs. |
Original Medicare does not include Part D prescription drug coverage.
To get prescription drug coverage, you would need to buy a standalone Part D Prescription Drug plan from an insurance company contracted with Medicare. You pay an additional monthly premium, copays/coinsurance, and deductible costs with stand-alone plans.
Medicare supplement plans help pay some of the health care costs and services that Original Medicare doesn’t cover, such as copays, coinsurance, deductibles, and care outside the US. You pay an additional premium for these plans, on top of your Medicare Part B premium. These are typically higher than those charged by Medicare Advantage plans.
Note: Medicare supplement plans do not cover Part D Prescription Drugs.
Medicare Advantage plans (Part C) are "all-in-one" plans where you can receive all your Part A (hospital) and Part B (medical) coverage PLUS your Part D prescription drugs all in one plan.
These plans cover everything that Original Medicare covers and many include important extras—dental, vision, hearing, over-the-counter, and wellness benefits. They may also cover urgent and emergency care while you travel.
A variety of plan types are offered, including PPO, LPPO, HMO, and HMO-POS plans. The plan type you choose will determine provider flexibility and cost shares.
You will continue to pay your Medicare Part B premium and some Medicare Advantage plans have an additional monthly premium.
Getting the extra coverage you need can help you stay healthy and save money. But, it's not always easy to figure out which option is best for your health care needs and preferences.
For a deeper dive into the differences between these two options, visit our Medicare Advantage vs. Medigap page. If you have questions, don't hesitate to give us a call to talk over your options at the phone number below.
We offer a variety of Medicare Advantage plans designed to fit your health care needs and budget.
Choose from over 15,000 providers who participate in the Generations Advantage network.
Use the Drug Formulary Search Tool to find detailed coverage information for specific medications.
This free guide can help answer your questions and give you valuable information about our plans.
Have additional questions? Join us for a free Medicare Advantage plan seminar. To fit your schedule, our sessions are available in-person or online.
Ready to enroll? Our enrollment process only takes about 10 minutes—have your Medicare card ready and let's get started.
Local benefit specialists available to help you with your questions or give you personalized assistance.