Medicare Step 2: Preview your coverage options

Medicare coverage options in the United States consist of several parts, each offering different types of healthcare coverage. Here’s an overview of the options:

Original Medicare

1. Medicare Part A (Hospital Insurance)

   • Covers: Inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
   • Cost: Most people don't pay a premium for Part A if they have paid Medicare taxes while working. There may be deductibles and coinsurance for services.

2. Medicare Part B (Medical Insurance)

   • Covers: Doctor visits, outpatient care, preventive services, and some home health care.
   • Cost: Part B usually requires a monthly premium, as well as a deductible and coinsurance for services.

Medicare Advantage (Medicare Part C)

• Medicare Advantage Plans: Offered by private companies approved by Medicare, these plans provide all Part A and Part B services and often include additional benefits like prescription drug coverage (Part D), dental, vision, hearing, and wellness programs.
• Types of Plans:
  • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)
  • Private Fee-for-Service (PFFS)
  • Special Needs Plans (SNPs)
• Cost: Typically, members pay a monthly premium (in addition to the Part B premium) and copayments/coinsurance. There’s an annual out-of-pocket maximum.

Medicare Part D (Prescription Drug Coverage)

• Covers: Prescription medications.
• Plans: Offered by private insurance companies and can be standalone (PDPs) or included in Medicare Advantage plans (MAPD).
• Cost: Monthly premiums, annual deductibles, and copayments/coinsurance for medications.

Medicare Supplement Insurance (Medigap)

• Covers: Costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles.
• Plans: Offered by private insurance companies and standardized across states (e.g., Plan A, Plan B, Plan C, etc.).
• Eligibility: Must have Original Medicare (Parts A and B).
• Cost: Monthly premiums in addition to Part B premium; costs vary by plan and provider.

Additional Options

1. Medicare Savings Programs: Help people with limited income and resources pay Medicare premiums and other costs.
2. Medicare Special Needs Plans (SNPs): Tailored for people with specific diseases or characteristics (e.g., chronic conditions, institutionalized individuals, or dual eligibles who have both Medicare and Medicaid).

Choosing the Right Option

When choosing a Medicare coverage option, consider:

• Healthcare Needs: Frequency of doctor visits, need for specialist care, prescription medications, etc.
• Costs: Premiums, deductibles, copayments, and out-of-pocket maximums.
• Provider Network: Access to preferred doctors and hospitals.
• Additional Benefits: Dental, vision, hearing, and other wellness benefits.

It's important to compare the different plans and options available to ensure you select the coverage that best fits your healthcare needs and financial situation.