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Medicare Insurance Plans and Coverage Options

Health, Resources

Medicare Insurance Plans and Coverage Options


When you are eligible for Medicare, there are some critical decisions you have to make. Decisions such as which Medicare insurance plan fits you best and provides you with all the necessary services.

There are several Medicare insurance plans and coverage options. They include; Original Medicare, Medicare Advantage, Part D, and Medicare Supplemental Insurance. These insurance plans differ in what they cover as well as their cost. Before settling for any coverage option, it is essential to understand what it entails, whether it suits your needs, and if it falls within your budget.

Original Medicare entails Part A and Part B insurance plans. You can decide to take both or choose one over the other. Often, most people prefer to take Part A over Part B if they can qualify for a premium-free option in Part A. Although Part D is often a part of Medicare Advantage, occasionally, it is added to Original Medicare. Once you decide on Part A and Part B, you can add a supplemental plan and Part D or a Medicare Advantage Plan.

Let us discuss further each of these plans for a better understanding.


Part A

This coverage option is the hospital insurance part of Original Medicare. It covers inpatient care, home health services, and care provided in a nursing home. The coverage has two categories, one that charges a monthly premium and the other that is premium-free.

To qualify for a premium-free Part A plan, you or your spouse must have paid Medicare (payroll) taxes for at least ten years. If you or your spouse did not pay these taxes, you only qualify for the coverage if you pay a monthly premium. The premiums consider the amount paid into the Medicare taxes if you have been paying for less than ten years. If you have paid more taxes, your monthly premium will be less than that of one who has paid fewer taxes.

Part B

The Part B option acts as the medical insurance part of Original Medicare. This plan covers expenses related to outpatient services, medical equipment, healthcare provider services, and preventative care.

The outpatient services include sick visits to the doctor or check-up visits. Medical equipment covered in the plan include; walkers, wheelchairs, and hospital beds, among others. Preventative care entails costs related to annual flu shots, yearly wellness visits, and screening for cancers (such as cervical, colorectal, and prostate).

Medicare Part B requires a monthly premium payment. Your annual income determines the premium amount you will pay. The higher your income is, the higher the premium you are likely to pay.

Medicare Advantage

This coverage is also the Medicare Part C plan. Private insurance companies approved by Medicare provide this coverage. The plan is a substitute for Original Medicare because it entails everything that Part A and B cover. In addition, most Medicare Advantage plans include prescription drug coverage (Part D) as well as extra benefits such as coverage of hearing, dental, and vision services.

Competition between private companies leads to lower charges as each tries to gain an advantage over the other. Therefore, Medicare Advantage tends to have lower out-of-pocket expenses than Original Medicare.

Part D

This plan is the drug coverage that covers the expenses of prescription drugs, and at times, it includes recommended vaccines and shots. To determine which prescriptions they will cover, each Medicare drug coverage plan adheres to a formulary created by a therapeutics and pharmacy committee consisting of physicians and pharmacists. This formulary requires approval from the Centers for Medicare and Medicaid Services (CMS) in the United States. Part D insurance plans must provide two drugs from each category necessary to treat your medical condition. In most cases, when a brand-name drug is not covered, a generic version is covered.

Part D is associated with different costs that vary depending on the type of plan you pick. These costs include; monthly premiums, annual deductibles, coinsurance, and copayment. If your income and resources are minimal and cannot cover all the costs, Medicare provides the “Extra Help” program that can assist you.

There are two ways you can join a drug coverage plan. You can either add it to the Original Medicare plan or get it by enrolling in a Medicare Advantage Plan that offers drug coverage.

Medicare Supplemental Insurance (Medigap)

Medigap is an insurance plan that fills gaps in Medicare and shares the costs associated with Original Medicare. Costs such as deductibles, copayments, and coinsurance. Medicare approves private insurers who can offer Medigap insurance.

Medigap is only available to those with Part A and Part B. If you have a Medicare Advantage Plan, you do not qualify for Medicare Supplemental Insurance. You might also not be eligible for the plan if you are below 65 or could end up paying more if you qualify.

For this plan, you pay a monthly premium and the monthly payment for Medicare Part B. The health insurance provider you purchased your Medigap coverage through receives the Medigap payment. On the other hand, Social Security Administration collects the Part B premium.

Medigap only covers certain costs within Part A and B. It is important to note that it does not cover costs associated with long-term care, dental services, vision care, prescription drugs, private-duty nursing, and hearing aids. Although, in some circumstances, when you go outside of the United States, some Medigap insurance plans can provide coverage.

You have a lot of alternatives when it comes to the insurance plans and coverage provided by Medicare. Picking the right one is crucial in ensuring your health is appropriately covered since the design of each insurance plan fulfills a specific function. Choosing one plan or combining different insurance plans depends on your needs and circumstances.

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