Medicare Parts C, D, and Medigap
Welcome to Understanding Medicare, a three-part video series from Priority Health. There’s a lot to learn when it comes to Medicare, and Priority Health is here to help. In this second video, we’ll discuss Medicare Advantage and Medigap plans.
Once you have Original Medicare which includes Parts A & B, you have options. Remember, Parts A and B only cover hospital and medical care. This is where Parts C, D, and Medigap come in.
“Original” Medicare (Parts A & B) is managed by the federal government. Medicare Advantage Plans (Part C), Medicare prescription drug plans (Part D), and supplemental plans, known as Medigap, are managed by private companies, like Priority Health.
Medicare Advantage, or “Part C”
A Medicare Advantage Plan combines hospital coverage (Medicare Part A) and medical coverage (Medicare Part B). Some Medicare Advantage Plans also include Medicare Part D prescription drug coverage and are known as MAPD plans.
Medicare Advantage Plans have predictable copayments, so you’re not surprised by how much you pay when you see your doctor. As a reminder, a copayment or copay is the fixed amount you pay for a covered health care service once you’ve paid your deductible in full. Medicare Advantage Plans may also have monthly premiums and a network of doctors and hospitals that participate in the plan. Some Medicare Advantage Plans even offer coverage for things like dental, vision, and gym memberships.
With Medicare Advantage Plans, you only need your health plan’s member ID card, so you can put away that red-white-and-blue Medicare card. To join a Medicare Advantage Plan, you must be enrolled in Medicare Parts A and B and live within the plan’s service area.
You’ll continue to pay your Part B premium to the government. You may also pay a separate monthly premium to your health coverage provider for your Medicare Advantage Plan.
Medicare Supplement (Medigap) Plans
If a Medicare Advantage Plan isn’t right for you, you can stick with Original Medicare (just Parts A & B) and purchase a Medicare Supplemental Insurance plan to cover costs that Original Medicare doesn’t. This coverage is often called a “Medigap” plan.
For example, if Original Medicare covers 80% of your doctor bill, a Medigap plan could cover the remaining 20%. It’s important to know that a Medigap plan only works with Original Medicare.
So, if you choose a Medigap plan, you can’t have a Medicare Advantage plan, and vice versa.
Medicare Part D prescription coverage
And finally, there’s Medicare Part D prescription drug coverage. Original Medicare and Medigap plans don’t include Part D, so if you choose one of these plans, you’ll need to purchase drug coverage separately through a private insurance company.
When to enroll
Now, let’s talk about enrolling. After you’ve signed up for Parts A & B, you can choose a Medicare Advantage Plan at any time during your initial seven-month enrollment period. This period includes the three months before your 65th birthday, the month of your birthday, and the three months after. Each year, you have the option to switch your Medicare Advantage or Part D prescription drug plan during the annual enrollment period which runs from October 15 to December 7.
You can sign up for a Medigap plan at any time, but the best time is during your open enrollment period because you’re guaranteed acceptance into a plan regardless of your health. Your 6-month Medigap open enrollment period begins on the first day of the month in which you are both 65 and enrolled in Medicare Part B. If you pass the enrollment period and apply for a Medigap plan later, your health will affect your acceptance and your premium.
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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