Understanding Your Medicare Options

September 28, 2023 | Tags: Medicare Understanding Medicare Advantage

Understanding Medicare doesn’t have to be like sifting through alphabet soup. While Medicare has several parts — Parts A, B, C and D — and can seem complex, this resource will provide you with a clear understanding, to the letter. There are two main ways to get coverage: through Original Medicare or Medicare Advantage.

First things first: What is Medicare?

Medicare is a health insurance program for those age 65 and over, and some younger people with disabilities. Parts A and B are offered by the federal government and together are known as Original Medicare. Parts C and D are offered through private insurance companies.

Original Medicare

These plans are offered through the federal government.

Medicare Part A: This covers inpatient hospital care and some inpatient rehabilitation services at skilled nursing facilities, hospice care and home healthcare. If you’ve worked at least 10 years while paying Medicare taxes, you most likely won’t have to pay a monthly premium for Part A, though there are other costs, such as deductibles, that you will need to pay. Learn more about Medicare Part A.
Medicare Part B: This covers doctor visits and other outpatient care (services that don’t require a hospital stay). It also covers ambulance services, some medical equipment and preventive health services such as colonoscopies and mammograms. You must pay a monthly premium set by the Centers for Medicare & Medicaid Services (CMS) for Part B. The average monthly premium in 2023 was $164.90. Learn more about Medicare Part B.

What is Medicare Supplement, or Medigap, insurance?

Medicare Part A and Part B are associated with some out-of-pocket costs. Medicare Supplement plans, which can be purchased from private-sector insurers, cover many of these costs. Learn how Medicare Supplement compares to Medicare Advantage.

Prescription Drug coverage (Medicare Part D)

(Yes, we’re tackling the alphabet a little out of order, but you’ll see why!)

This is an optional prescription drug benefits plan available through private-sector insurers. It is available to anyone enrolled in Medicare Part A or B for a monthly premium and is often included with Medicare Advantage plans (Part C, see below). Consumers typically select a drug coverage plan based on what will offer the best copay cost for their medications. Learn more about Medicare Part D.

Medicare Advantage (Medicare Part C)

Medicare Advantage combines Part A and Part B together. Medicare Advantage can also include prescription drug coverage (Part D), dental, vision and hearing options

Medicare Advantage offers an inclusive approach, combining both Parts A (hospitalization) and Part B (outpatient services). These plans are offered through private-sector health insurance companies, like Medical Mutual. You’ll choose either an HMO plan or PPO plan and utilize its network of caregivers. There is usually a monthly cost for Medicare Advantage plans, though some plans have a $0 premium.

You continue to pay your Medicare Part B premium when enrolled in a Medicare Advantage plan. However, Medicare Advantage plans tend to come with lower out-of-pocket costs, such as deductibles and copays, compared with Original Medicare.

Medicare Advantage plans also often include prescription drug coverage (Part D), dental coverage and vision coverage. There are also extras such as allow allowances for over-the-counter supplies and eyewear, hearing aid discounts and access to programs like SilverSneakers.^®

Learn more about Medicare Part C.