Medicare Plan Types

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Original Medicare $$$

When you are on Original Medicare, you will pay your Part B premium, (and possibly a Part A premium as well if you have one). Part A is your hospital coverage and may require copayments, coinsurances, or deductibles based on the service your receive. Part B is your medical coverage and may require copayments, coinsurances, or deductibles based on the service your receive. After your Part B deductible is met, this coverage will cover 80% of your Part B costs and you will pay the remaining 20% up to a no limit amount. There is no maximum out of pocket for this coverage. You may access any doctor in the country who accepts Original Medicare without a referral. (Unless the office you are choosing to see requires it. Some will require it whether your insurance does or not.) This coverage does not include Part D prescriptions. If you choose to use Original Medicare, it is optional to purchase a Part D plan in addition. If you are not currently taking prescriptions and choose to decline this coverage, you may be responsible for a late enrollment penalty if you enroll at a later time when you may need prescriptions.

Medigap $$

With a Medigap plan, better known as a Medicare Supplement, you will use your Original Medicare to pay your Part A and Part B services and your Supplement to cover any copayments, coinsurance, or deductibles you receive—depending which plan you choose. These are the "letter plans" you may have heard of. You will continue to pay your Medicare Part B premium (and possibly a Part A premium as well if you have one) as well as a premium for your Supplement coverage. In addition, although optional, you will also need to obtain a Part D plan for your prescriptions at an additional premium. If you are not currently taking prescriptions and choose to decline this coverage, you may be responsible for a late enrollment penalty if you enroll at a later time when you may need prescriptions. Most supplements do not cover the bells and whistles but some may cover a few. This coverage will give you access to any doctor in the country who accepts Original Medicare without a referral as long as it is not a policy of the office you are trying to be seen at.

Medicare Advantage $-$$

When you are on a Medicare Advantage plan, you will continue to pay your Part B premium (and possibly a Part A premium as well if you have one) and depending on which plan you choose, no premium up to an additional premium plus copays for your services, usually up to a limited amount. Many of these plans also include drug coverage at no additional cost—if you choose a plan with drug coverage. Many of these plans also provide the bells and whistles you may have heard about and some plans are even catered to providing extra help for those with special needs such as certain chronic health conditions like congestive heart failure, cardiovascular disease, diabetes, and certain breathing conditions such as COPD. Depending on which Medicare Advantage plan you choose, you may (PPO) or may not (HMO) be able to access doctors without a referral and many plans are limited to a network. Note: There are some HMO plans out there that may allow you to see in network doctors without a referral. However, seeing a doctor without a referral still depends on the policy of the office you are trying to be seen at.