Many people find that Original Medicare (Part A hospitalization and Part B medical services) won’t cover all of your health care cost and that you may need to supplement your coverage.
The next step is to decide whether a Medicare Advantage or a Medigap plan is right for you.
Medicare Advantage with prescription drug (MAPD) plans include all of the coverage that you get with Original Medicare plus so much more. MAPD plans can help lower your out-of-pocket maximums. MAPD plans also cover prescription drugs and can include extras, like dental or gym membership. You’ll make the most of your plan when you see doctors in the plan’s network. This type of plan may be right for you if:
- You want predictable copayments, deductibles and an out-of-pocket maximum.
- Paying lower monthly payments is important to you.
- You want to have your Part D prescription coverage bundled with your Parts A and B coverage
- Want additional coverage even though you have a pre-existing condition
- You want to see doctors in the plan’s network, which will save you money
Medigap plans work side-by-side with Original Medicare to help cover cost like copayments, coinsurance and deductibles that Original Medicare doesn’t cover. They don’t include prescription drug coverage, but they do give you the flexibility to see any doctor who accepts Medicare. This type of plan may be right for you if:
- You don’t mind paying a higher monthly premium but paying less-or-nothing- when you get medical care.
- You live outside of you resident state for more than a month each year and want to see routine health services when you’re away
- You don’t want to worry about staying in-network for your services to be covered because Medigap plans don’t use networks
- You don’t care about having a stand-alone Part D prescription drug plan.
What’s the difference between Original Medicare, Medicare Advantage, and Medigap?
Original Medicare is the Part A (hospitalization) and Part B (medical services) coverage you get through the federal government. Part A covers most hospital cost after you pay the first $1,340.00 (your 2017 Part A deductible). Most people don’t pay a monthly Part A premium because they have paid for it through their payroll deductions while working. Part B covers 80% of the cost of doctors visits and everyday medical services after you pay the first $183 (your 2018 Part B deductible). You’ll pay a Part B monthly premium and usually 20% of the Medicare-approved cost for out-patient care. There is no prescription drug coverage included with Original Medicare.
Medicare Advantage plans give you the same coverage you get with Original Medicare, plus they cover a lot more. These plans, offered through private insurers, Priority Health, BCBS, Humana , HAP, are required by the federal government to include all of the benefits you get with Original Medicare, so you won’t lose any coverage, you’ll only get more. Some Medicare Advantage plans include $0 premium, but if it doesn’t , you’ll pay a monthly premium in addition to any Part A and Part B premiums you may have. When you choose one of these plans, you can put away your red-white-and blue Medicare card, you’ll use the card you get from your private insurer.
There are several different standard Medigap (Medicare supplement) plans. Each one has different benefits that help cover costs like copayments, coinsurance, and deductibles that Original Medicare doesn’t cover. The benefits are set by the government so no matter which insurance carrier you choose, the coverage will be the same. The differences you see will be in monthly premiums and customer service performance. Medigap plans do not include prescription drug coverage. These plans also don’t normally include things like dental, hearing or a gym membership. You’ll pay a monthly premium in addition to any Part A and Part B premiums you may have. You can’t enroll in a Medigap plan if you have a Medicare Advantage plan.