Coverage types
Welcome to Understanding Medicare, a three-part video series from Priority Health. When it comes to Medicare, one size does NOT fit all. You have a lot of choices, which we’ll explain in this third video. Medicare coverage has many pieces, parts, and plans—how you combine them depends on your medical needs, your lifestyle and your budget.
Is Original Medicare all you need?
Medicare coverage begins with Original Medicare. This includes Part A and Part B coverage and is offered by the federal government.
Part A is primarily hospital coverage. It usually has no premium and covers about 80% of hospital care.
Part B is medical coverage for things like doctor visits. You’ll pay a premium and deductible to the federal government.
If you don’t go to the doctor often, have medical coverage through your employer, TRICARE, or the Veterans Administration, Original Medicare may be right for you.
Once you’ve signed up for Parts A and B, you can choose to add coverage with a Medicare Advantage or Medigap plan. Let’s review those two choices in more detail.
Why add a Medigap Plan?
Since Original Medicare doesn’t pay 100% of medical costs, you can choose to purchase a Medigap plan that helps pay costs not covered by Original Medicare. Some Medigap plans cover the 20% that Original Medicare doesn’t cover, so your out-of-pocket expenses will be lower. Typically, these plans have higher monthly premiums than a Medicare Advantage Plan, but you usually pay less for any services.
These plans are offered and managed by private companies, like Priority Health.
Medigap plans give you the freedom to see any doctor who accepts Medicare, but you might have to pay a Medicare Part A and/or Part B deductible.
Neither Original Medicare nor Medigap covers prescription drugs. However, you can choose to add Medicare Part D coverage from a private company.
Medicare Advantage (Part C)
Another option is a Medicare Advantage Plan, also known as Medicare Part C. These plans combine coverage for doctor visits, hospitalization and often prescription drugs into a single plan, similar to the health coverage many Americans are used to. They include:
- HMOs: plans that require you to choose a primary care provider and get referrals to see a specialist. With an HMO, you’ll need to see doctors within your plan’s network or possibly pay the full cost of care.
- PPOs: plans that offer more flexibility in choosing doctors and won’t require a referral to see a specialist. With a PPO, you can see out-of-network doctors, but it may cost more.
- and
- Special Needs Plans: plans tailored for specific groups, including individuals with chronic conditions like diabetes and those eligible for both Medicaid and Medicare.
Medicare Advantage Plans may have monthly premiums and deductibles, but you’ll enjoy predictable co-payments and typically save money when you see doctors within the plan’s network.
Why add Medicare Advantage or MAPD?
One big difference between Medicare Advantage and Medigap plans is that some Medigap plans, when combined with Original Medicare, cover 100% of the cost of services but will often have a higher monthly premium, while a Medicare Advantage Plan will typically have a lower monthly premium and predictable copays for services.
Some Medicare Advantage Plans even offer coverage for things like Part D prescription drugs, dental, vision, hearing and gym memberships. If you want the simplicity of a single plan, don’t need to see an out-of-network doctor too often and want a plan that could offer the option of prescription drug coverage, a Medicare Advantage Plan might be for you.
Whichever you choose, your first step is to enroll in Original Medicare (Parts A and B). You may be enrolled automatically if you’re already collecting Social Security benefits.
To enroll, visit your local Social Security Administration office, call them at the number provided, or sign up online at ssa.gov.
You can learn more about Medicare, including how to choose coverage that’s right for you, at PriorityMedicare.com. Thanks for watching!
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