What is Medicare?
Medicare is a federal health insurance program through the Centers for Medicare & Medicaid Services (CMS). The Social Security Administration started Medicare to help people pay for their health costs if they’re 65 or older or have certain disabilities. It is mostly paid for by payroll taxes and premiums paid by Medicare beneficiaries.
Medicare has four parts.
Part A – Hospital Coverage (inpatient hospital stays, skilled nursing facilities, hospice and some home health care)
Part B – Medical Coverage (doctor visits, outpatient care and some home health care)
Part C – Medicare Advantage (from a private company and pays in place of Original Medicare)
Part D – Prescription Drug Coverage
At a Glance: Medicare Coverage Options
|Original Medicare||Medicare Advantage||Medicare Supplement|
|Managed by||Federal Government||Private Insurance Companies||Private Insurance Companies|
|Coverage||Limited to what Medicare covers||Often covers services Medicare dosen't like dental, vision and hearing||Limited to what Medicare covers|
|Prescription Coverage||No||Most plans include Rx coverage||No|
|Provider Network||No||Yes, some plans allow you to see any doctor or hospital that accepts Medicare||No|
|Monthly Cost||Most people pay a Part B premium||Part B premium + monthly premium (if applicable)||Part B premium + monthly premium|
Original Medicare (Parts A and B)
Original Medicare is the traditional Medicare program managed by the federal government. It includes Part A and Part B coverage but only covers about 80% of your healthcare costs. Original Medicare does not include coverage for prescription drugs (Part D plan). You should consider signing up for a separate Part D plan to ensure that you have coverage for your prescription drug needs.
Medicare Advantage (Part C)
Medicare Advantage combines all your coverage (doctor’s visits, hospital and pharmacy) into one plan, like the health plan you might have been used to while you were working. In addition, Medicare Advantage plans often cover services that Medicare doesn’t cover like care coordination, health coaching, dental, vision and hearing. Medicare Advantage plans have yearly limits to keep your out-of-pocket costs lower. Original Medicare does not. Medicare Advantage $0 premium plans have become popular recently, where you do not have to pay a monthly premium for the plan, you must still pay your Part B premium.
Medicare Supplement (Medigap)
Medicare Supplement plans help pay for the costs that Original Medicare doesn’t pay for, like coinsurance, copayments and deductibles. With these plans the government sets the rules, and the plans only cover services that Original Medicare covers. Medicare Supplement plan premiums often increase with age. They also do not include coverage for prescription drugs (Part D plan). You should consider signing up for a separate Part D plan to ensure that you have coverage for your prescription drug needs.
Things to Consider When Choosing a Medicare Plan:
- Ensure you can continue to see your doctor
- Review the formulary (drug list) to make sure your drugs are covered
- Look at how your past healthcare costs line up with a plan. Consider if there is an opportunity to change plans to save money.
- Look for additional plan perks, like health coaching and care coordination, fitness benefits and more.
- Check to see if you’re eligible for Extra Help through Medicare.
Medicare: 800-Medicare (800-633-4227)
Call to request Medicare info, enroll in a Medicare plan, verify Extra Help status or find state health insurance counselors.
Social Security Administration: 800-772-1213
Call for issues regarding Extra Help, like enrolling, verifying status or getting more info.
Also call to enroll in Medicare or schedule monthly premiums to be withdrawn from Social Security.
U.S. Railroad Retirement Board: 877-772-5772
Call to schedule monthly premiums to be withdrawn from the U.S. Railroad Retirement Board.