After you enroll in Original Medicare (Parts A and B), there are two ways to get additional coverage. You can enroll in a Medicare Supplement Plan along with a Prescription Drug Plan, or you can enroll in a Medicare Advantage Plan which typically includes a Prescription Drug Plan.
Of course, deciding which plan is best for you will depend upon several key factors and that’s where we can help you with an in-depth personal needs analysis.
What is Covered Under Original Medicare?
Medicare Part A:
- Hospital Insurance: Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
- Inpatient Hospital Care: Includes semi-private rooms, meals, general nursing, and other hospital services and supplies.
- Skilled Nursing Facility Care: Covers care in a skilled nursing facility certified by Medicare.
- Hospice Care: Provides services like doctor services, nursing care, medical equipment, hospice aide, and respite care for terminal illness.
Medicare Part B:
- Medical Insurance: Covers outpatient care, doctor visits, preventive services, and medical supplies.
- Doctor Visits: Includes visits to doctors and other health care providers.
- Outpatient Care: Covers services like lab tests, X-rays, outpatient surgeries, and durable medical equipment (DME).
- Preventive Services: Includes flu shots, screenings (e.g., for cancer, diabetes, and cardiovascular disease), and annual wellness visits.
- Some Home Health Care: Covers certain medically necessary services like parttime skilled nursing care, physical therapy, and speech-language pathology services.
It’s important to note that Medicare Part A is generally premium-free for most people who have worked and paid Medicare taxes for a sufficient duration. Medicare Part B requires a monthly premium, which is income-based.
What are my costs associated with Medicare Part A and Part B?
Medicare Part A (Hospital Insurance):
- Premium: For most people, Part A is premium-free if you or your spouse paid Medicare taxes while working.
- Deductibles: The inpatient hospital deductible in 2024 is $1632 per benefit period.
Medicare Part B (Medical Insurance):
- Premium: The standard premium amount is $174.70 per month in 2024, but this can vary depending on your income.
- Deductible: You must pay an annual deductible of $240 before Medicare starts to pay its share.
- Co-insurance/Co-payment: Generally, you pay 20% of the Medicare-approved amount for most doctor services, outpatient hospital services, and durable medical equipment.
Medicare Advantage Plans/Part C
If you have Part A and Part B, you can join a Medicare Advantage Plan, sometimes called “Part C”. This type of Medicare health plan is offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D).
Insurance companies can decide if a plan will be available to everyone with Medicare in a state, or only in certain counties. Insurance companies may also offer more than one plan in an area, with different benefits and costs. Each year, insurance companies can decide to join or leave Medicare.
Each year, plans set the amounts they charge for premiums, deductibles, and services. The plan (rather than Medicare) decides how much you pay for the covered services you get. What you pay the plan can only change once a year, on January 1.
There’s no yearly limit on what you pay out of pocket under original Medicare. Medicare Advantage Plans have a yearly limit on what you pay out of pocket. Once you reach your plan’s limit, you’ll pay nothing for covered services for the rest of the year. Plans must cover all medically necessary services that Original Medicare covers. Plans may also offer some extra benefits that Original Medicare doesn’t cover— like certain vision, hearing, and dental services.
Medicare Supplement Plans/Medigap
Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private health insurance company to help pay your share of out-of-pocket costs in Original Medicare.
All Medigap policies are standardized. This means policies with the same letter offer the same basic benefits no matter where you live or which insurance company you buy the policy from. There are 10 different types of Medigap plans offered in most states, which are named by letters: A-D, F, G, and K-N. Price is the only difference between plans with the same letter that are sold by different insurance companies.
Medigap doesn’t cover everything. Medigap plans generally don’t cover:
- Vision
- Dental care
- Hearing aids
- Eyeglasses
Prescription Drug Plans
All plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain protected classes. A plan’s list of covered drugs is called a “formulary,” and each plan has its own formulary. Medicare drug coverage typically places drugs into different levels, called “tiers,” on their formularies. Drugs in each tier have a different cost. For example, a drug in a lower tier will generally cost you less than a drug in a higher tier.
Under Original Medicare and Medigap policies, Prescription Drug Plans must be purchased separately. Most Medicare Advantage Plans include drug coverage.
There is a late enrollment penalty that can be added to your Medicare drug coverage (Part D) premium. You may have to pay a late enrollment penalty if at any time after your Initial Enrollment Period is over, there’s a period of 63 or more days in a row when you don’t have Medicare or other creditable prescription drug coverage. You’ll generally have to pay the penalty for as long as you have Medicare drug coverage.
Dental/Hearing/Vision Coverage
Original Medicare doesn’t cover benefits like eye exams, most dental care, and routine exams. Stand-alone dental, hearing, or vision plans can be purchased separately.
Medicare Advantage plans may offer some extra benefits that Original Medicare doesn’t cover – like certain vision, hearing, and dental services.
As a licensed agents, we can help you better understand your Medicare options and help you choose the plan that’s right for you. Finding a plan that provides you with value and access to quality care is important. We welcome the opportunity to discuss how a Medicare plan can fit your budget and lifestyle. We can also find out if you’re eligible for Extra Help and other money-saving programs, and assist with your application. Contact us at (302) 202-4408 to learn more.
You can also review, compare and self enroll in available plans in your zip code by clicking below, then contact us to review and answer your questions. Any DSNP cost sharing, if any at all, will be determined by level of eligibility.
*Please note: Not all Medicare Insurance providers participate with this system.
Not affiliated with the U.S. Government or Federal Medicare program.
