Medicare is a federal health insurance program for people who are 65 or older, and under 65 with certain disabilities or End-Stage Renal Disease. It was enacted in 1965.

There are four parts of Medicare: A, B, C, and D, with each part offering a different level of coverage for healthcare services.

Original Medicare

Medicare Part A (hospital insurance) and Part B (medical insurance) are known as Original Medicare. Together, these parts cover an array of inpatient and outpatient services, like:

  • Hospice care
  • Home health care
  • Preventative services
  • Skilled nursing facility care
  • Durable medical equipment
  • Some outpatient prescriptions

If you or your spouse paid Medicare taxes during your working years, you may get Part A premium-free. But you’ll still need to pay the Part B premium.

Medicare Supplements

Medicare Supplement plans, also called Medigap policies, are extra insurance that add to your Original Medicare benefits. Original Medicare doesn’t cover everything. Depending on your health, you could still pay deductibles, copays, and coinsurance — out of pocket — when you receive services. Medicare Supplements are meant to fill in these “gaps” in coverage, and some even cover foreign travel emergency care and Medicare excess charges.

The plans are A, B, C, D, F, G, K, L, M, and N — each covering a percentage of benefits. Plans F and G offer high-deductible versions, meaning you have to meet the deductible amount before the plan pays anything. As of 2021, the deductible is $2,370.

However, Plans C and F are not available like they used to be. Those eligible for Medicare before 2020 will continue to have the option to enroll in these Medigap plans later on. This is due to the Medicare Access and CHIP Reauthorization legislation that prohibits supplements from covering the Medicare Part B deductible.

Medicare Advantage

Medicare Advantage, also called Part C, are plans offered by private insurance companies approved by Medicare. These plans are required to provide the same benefits as Original Medicare, and some may have additional coverage, such as fitness programs, transportation, wellness services, dental, vision, hearing, and even prescription drugs.

You must be enrolled in both Parts A and B, and then you may enroll in an Advantage plan.

There are many Advantage plans to explore:

  • HMO plans typically require you to see only providers that are in-network and get referrals from a primary care physician.
  • PPO plans, in most cases, don’t require referrals from a primary care doctor. You also pay less if you use doctors in the plan’s network.
  • PFFS plans allow you to visit any doctor approved by Medicare, hospital and provider that takes the plan’s payment, terms and conditions and agrees to treat you.
  • MSA plans combine a high-deductible plan and a savings account to pay for your medical expenses. The plan will deposit money into the account, and you can use this to pay healthcare costs before meeting the deductible.
  • SNPs have a unique benefits package for those with special healthcare needs. The three types of SNPs are C-SNP, D-SNP, and I-SNP. All SNPs must provide Medicare prescription drug coverage.

Veterans with TRICARE and VA benefits may also enroll in a Medicare Advantage plan — which extends their health coverage beyond the VA networks.


Medicare Prescription Drug Coverage

Medicare Part D is the prescription drug benefit. Beneficiaries can purchase this coverage in two ways: 1) As a separate, standalone plan with Original Medicare or 2) As an additional benefit with a Medigap plan or some Advantage plans like PFFS, MSA, or a Medicare cost plan.

Part D plans, often called PDPs, need to cover a minimum of two drugs within each of these classes:

  • Anticancer
  • Antipsychotics
  • Antidepressants
  • Anticonvulsants
  • HIVS/AIDS drugs
  • Immunosuppressants 

Each plan has a list of drugs it covers called a formulary. So, the insurance company who provides the plan decides which drugs in each category will be covered. You should check the formulary of the plan you’re applying for to make sure your medications are included.

Reach Out to Our Team

Depending on where you live, there may be dozens of Medicare Advantage, Supplement, and prescription drug plans. How do you know which is right for you? An experienced agent will walk you through your options and help you make an informed decision! And it comes at no additional cost. Call us today for FREE Medicare help.