Understanding Medicare Options

What is Medicare?

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. Different parts of Medicare cover specific services.

Medicare Part A (Hospital Insurance)

Medicare Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Most people don't pay a premium for Part A because they or their spouse paid Medicare taxes while working.

What it covers:

• Hospital care
• Skilled nursing facility care
• Nursing home care (as long as custodial care isn't the only care needed)
• Hospice
• Home health services

Medicare Part B (Medical Insurance)

Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. Most people pay a standard monthly premium for Part B.

What it covers:

• Doctor visits
• Outpatient care
• Preventive services
• Clinical research
• Ambulance services
• Durable medical equipment
• Mental health services
• Limited outpatient prescription drugs

Medicare Part C (Medicare Advantage)

Medicare Advantage is an alternative to Original Medicare (Parts A and B) offered by private companies approved by Medicare. These plans often include Part D drug coverage and may offer extra benefits that Original Medicare doesn't cover.

What it covers:

• All Part A and Part B services (except hospice care)
• Usually includes prescription drug coverage
• May include additional benefits like vision, hearing, and dental
• May include wellness programs

Types of Medicare Advantage plans:

• Health Maintenance Organization (HMO) plans
• Preferred Provider Organization (PPO) plans
• Private Fee-for-Service (PFFS) plans
• Special Needs Plans (SNPs)
• HMO Point of Service (HMOPOS) plans
• Medical Savings Account (MSA) plans

Medicare Part D (Prescription Drug Coverage)

Part D adds prescription drug coverage to Original Medicare and some Medicare Advantage Plans. These plans are offered by private companies approved by Medicare.

What it covers:

• Prescription medications
• Recommended vaccines (like the shingles vaccine)

Medicare Supplement Insurance (Medigap)

Medigap is private insurance that helps pay some of the health care costs that Original Medicare doesn't cover (like copayments, coinsurance, and deductibles). Policies are standardized and identified by letters A through N.

What it covers:

• Medicare Part A coinsurance and hospital costs
• Medicare Part B coinsurance or copayment
• Blood (first 3 pints)
• Part A hospice care coinsurance or copayment
• Skilled nursing facility care coinsurance
• Part A deductible (some plans)
• Part B deductible (some plans)
• Part B excess charges (some plans)
• Foreign travel emergency (some plans)

Comparing Your Options

When choosing between Original Medicare and Medicare Advantage, consider:

• Cost: Premiums, deductibles, copays, and coinsurance
• Coverage: Services and benefits included
• Doctor choice: Network restrictions
• Quality of care: Ratings and reviews
• Convenience: Location and travel considerations
• Prescription needs: Drug formularies and coverage