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What Are My Options When It Comes To Medicare?

If you’re new to Medicare, there’s a lot to consider when evaluating your options. For some, you can get Medicare Part A & B automatically, but others will need to sign up through Social Security or SSA.gov. While Original Medicare (Part A and Part B) covers your hospital and medical services, covering all your needs may require a few more decisions:

• You may need a Medicare Part D plan for prescription drug coverage. Enrollment options include: Medicare.gov, directly from a private insurance company, or a CMS-appointed health insurance marketplace like Medicare Advisors Insurance Group.

• A Medicare Supplement plan (Medigap) will help cover the remaining 20% of what Original Medicare does not cover. Enrollment options include: Directly from a private insurance company or a CMS-appointed health insurance marketplace like Medicare Advisors Insurance Group.

• Medicare Advantage is another option that includes Original Medicare (Part A and Part B) and may include Part D, vision, and dental all in one plan. Enrollment options include: Medicare.gov, directly from a private insurance company, or a CMS-appointed health insurance marketplace like Medicare Advisors Insurance Group. We’ll dive deeper into the details of Medicare plans and coverage to help you better understand your options.

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What Are My Options When It Comes To Medicare?

If you’re new to Medicare, there’s a lot to consider when evaluating your options. For some, you can get Medicare Part A & B automatically, but others will need to sign up through Social Security or SSA.gov. While Original Medicare (Part A and Part B) covers your hospital and medical services, covering all your needs may require a few more decisions:

• You may need a Medicare Part D plan for prescription drug coverage. Enrollment options include: Medicare.gov, directly from a private insurance company, or a CMS-appointed health insurance marketplace like Medicare Advisors Insurance Group.

• A Medicare Supplement plan (Medigap) will help cover the remaining 20% of what Original Medicare does not cover. Enrollment options include: Directly from a private insurance company or a CMS-appointed health insurance marketplace like Medicare Advisors Insurance Group.

• Medicare Advantage is another option that includes Original Medicare (Part A and Part B) and may include Part D, vision, and dental all in one plan. Enrollment options include: Medicare.gov, directly from a private insurance company, or a CMS-appointed health insurance marketplace like Medicare Advisors Insurance Group. We’ll dive deeper into the details of Medicare plans and coverage to help you better understand your options.

New to Medicare Enrollment Tips

What Is Medicare Part A?

Medicare Part A is hospital insurance. Part A covers inpatient hospital care, limited time in a skilled nursing care facility, limited home health care services, and hospice care.

Medicare Part A typically doesn’t cover the full amount of your hospital bill, so you will probably be responsible for a share in the cost. You will also have to pay a deductible before Medicare benefits begin. Medicare will then pay 100% of your costs for up to 60 days in a hospital or up to 20 days in a skilled nursing facility. After that, you pay a flat amount up to the maximum number of covered days. Your Medicare Part A benefits cover some of the costs for a total of 90 days in a hospital and 100 days in a skilled nursing facility. Medicare also covers up to 60 “lifetime reserve days.” These are days you stay in a hospital longer than 90 days in a row. You get a lifetime total of 60 reserve days.

Medicare Part A typically doesn’t cover the full amount of your hospital bill, so you will probably be responsible for a share in the cost. You will also have to pay a deductible before Medicare benefits begin. Medicare will then pay 100% of your costs for up to 60 days in a hospital or up to 20 days in a skilled nursing facility. After that, you pay a flat amount up to the maximum number of covered days. Your Medicare Part A benefits cover some of the costs for a total of 90 days in a hospital and 100 days in a skilled nursing facility. Medicare also covers up to 60 “lifetime reserve days.” These are days you stay in a hospital longer than 90 days in a row. You get a lifetime total of 60 reserve days.

Medicare Part B

Medicare Part B is medical insurance. Part B benefits cover certain non-hospital medical expenses like doctors’ office visits, blood tests, X-rays, diabetic screenings and supplies, and outpatient hospital care.

You pay a monthly premium for this part of Original Medicare. The fee can be higher for people with high incomes. A different government program, Medicaid, can help cover Medicare Part B premiums for low-income beneficiaries.

Medicare Part B beneficiaries are usually responsible for a portion of their health care costs. You’ll have to pay a small deductible each year before your Medicare Part B benefits kick in, and then you’ll generally pay 20% of the bill when you go to a participating Medicare doctor. Medicare pays the full cost of many lab tests and services requested by your doctor.

Medicare Part C

Medicare Part C, or Medicare Advantage, insurance often includes every type of Medicare coverage in one health plan. It’s offered by private insurance companies contracted through CMS to provide a Medicare benefits package as an alternative to Original Medicare. Medicare Advantage is optional, but to obtain this private insurance, you must also have Original Medicare, Part A and Part B. You also continue to pay your Part B premium if you have a Medicare Advantage plan. Browse Medicare Advantage plans

While Medicare Advantage plans are required to provide all Medicare Part A and Medicare Part B benefits (except hospice care), plans can also include different additional benefits, which vary among the individual private health insurers. Many Medicare Advantage plans include prescription drug coverage. Some plans might have a lower deductible, while also allowing you to pay a smaller share of the remaining costs. Medicare Advantage plans may even cover certain health care services that Original Medicare, Part A and Part B, does not cover, like eye exams, hearing aids, dental care, or health care received while traveling outside the United States.

Medicare Part D

Medicare Part D is optional prescription drug coverage. Medicare Part D is available as a stand-alone plan through private insurance companies, and the monthly fee varies among insurers. You will share in the costs of your prescription drugs according to the specific plan in which you’re enrolled. Those costs can include a deductible, a flat copayment amount, or a percentage of the full drug cost (called “coinsurance”).

Browse Medicare Part D plans If you want prescription drug coverage, you can get it through a Medicare Advantage plan if there’s one in your area that offers this coverage. You can use the simple form on this page and enter your zip code to view a list of Medicare Advantage plans in your area. If you have limited income and cannot afford your medications even though you receive Medicare Part D benefits, you may qualify for the Extra Help program, which offers financial assistance for your monthly premium, deductible, copayment, or coinsurance.