Medicare Insurance Plans

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Medicare Insurance Plans

Get Quotes & Compare Plans Now

Medicare Insurance Plans

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Medicare Insurance Plans: What You Need to Know

You’ve worked hard to earn Medicare, now find a Medicare Insurance plan that works hard for you!

We understand how confusing it can be to find the Medicare plan that best fits your needs, but it doesn’t have to be. By working with trusted partners, we can help connect you with a plan that fits your lifestyle and your budget. We can help you learn more about your options and make shopping for Medicare coverage as easy as possible.

Medicare Basics

There are number of ways that Medicare plans are described, starting with 4 parts.

  • Medicare Parts A and B—This is Original Medicare provided by the government. Original Medicare covers hospital care and medical coverage. Medigap and Medicare Advantage plans are both ways to supplement your Medicare coverage.
  • Medicare Part C—This is a bundled insurance policy that typically covers Part A, B, and D with one plan for all Medicare coverage. These are also called Medicare Advantage plans.
  • Medicare Part D—prescription drug coverage offered by private insurers. It helps cover the cost of prescription drugs. Often this is referred to as a PDP or Prescription Drug Plan.

What do Medicare Plans Cover?

Medicare Supplement Plans

Medigap plans help fill the coverage gaps left by Original Medicare. They can help lower the out-of-pocket costs of Part A and Part B Medicare and give you more comprehensive coverage. There are ten types of Medigap plan—labeled A, B, C, D, F, G, K, L, M, and N—each offering different coverage (The letters of Medigap plans are not linked to the same letters as used for the Parts of Medicare). The plans are standardized, meaning a type K plan from one insurer will offer the same coverage as a type K plan from another insurer.

Explore Medigap Plans

Medicare Advantage Plans

Medicare Advantage plans provide coverage equal to Part A and Part B of Original Medicare, however, your hospice care will stay covered through Original Medicare Part A even you if you enroll in a Medicare Advantage Plan. In addition to providing the same coverage as Original Medicare, a Medicare Advantage plan may provide additional benefits. If you choose a Medicare Advantage plan with Prescription Drug coverage you will not need to buy an additional Part D plan.

Explore Medicare Advantage

Prescription Drug Plans

Medicare Prescription Drug Plans, also known as Part D plans, provide coverage for your prescription drug needs. These plans work with Original Medicare and help ensure your prescription drugs remain affordable. Part D coverage is available as a stand alone plan or may be included as part of other Medicare plans.

If you choose to stick with an Original Medicare plan that does not include Part D coverage then choosing a this type of plan is essential. Prescriptions drugs are a major portion of average senior healthcare costs so it’s important to get additional coverage to save money.

Explore Prescription Drug Plans

Tips for Choosing a Medicare Plan

Choosing a Medicare plan can be a daunting task. There are many factors to consider, such as your health needs, your budget, and your lifestyle.

Here are a few things to keep in mind when choosing a Medicare plan:

  • Your health needs: If you have chronic health conditions, you may need a plan that offers more comprehensive coverage. You will also want to account for the network providers is seeing certain doctors is important to you.
  • Your budget: Medicare plans can vary in cost, so it is important to find a plan that fits your budget. It’s important to look at all the factors between the plans and plan types; plan costs, premiums, and out-of-pocket expenses to get a complete picture of how much your healthcare may cost on Medicare.
  • Your lifestyle: If you travel frequently, you may want to choose a plan that has a wider network of providers.

Since the plans and rules are always changing, it pays to shop your coverage every year to get the best fit for your needs. One of the best ways to make sure you are getting the fit you need is to talk with a licensed insurance agent. It is the fastest, easiest way to get your questions answered and to get multiple quotes to compare your options.

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Exploring Medicare Parts A and B

Medicare Part A and Part B form the foundation of the program, offering essential coverage for hospital and medical services. Let’s delve into the details of each part, including coverage, costs, and services not covered.

Medicare Part A (Hospital Insurance) and its Coverage: Medicare Part A, also known as Hospital Insurance, provides coverage for inpatient hospital care, skilled nursing facility care, hospice care, and some home health services. Here is a breakdown of the coverage provided by Part A:

  1. Inpatient Hospital Care: Part A covers services received during an inpatient stay in a hospital, including room and board, nursing care, meals, and necessary hospital supplies and services. This coverage encompasses both critical care and general hospitalization.
  2. Skilled Nursing Facility Care: If you require skilled nursing care following a hospital stay, Medicare Part A covers a portion of the costs for up to 100 days in a skilled nursing facility. This includes skilled nursing care, rehabilitation services, and other necessary medical services.
  3. Hospice Care: Medicare Part A provides coverage for hospice care, including pain management, counseling, and support services for individuals with terminal illnesses. This coverage focuses on maintaining comfort and quality of life.
  4. Home Health Services: Part A covers medically necessary home health services, such as skilled nursing care, physical therapy, and speech-language pathology services, provided by a Medicare-certified home health agency.

Medicare Part B (Medical Insurance) and its Coverage: Medicare Part B, also known as Medical Insurance, covers medically necessary services, preventive care, and outpatient care. It helps pay for doctors’ services, outpatient hospital care, durable medical equipment, laboratory tests, and more. Here is an overview of the coverage provided by Part B:

  1. Doctor’s Services: Medicare Part B covers visits to doctors, specialists, and other healthcare providers. This includes services like office visits, consultations, and preventive screenings.
  2. Outpatient Hospital Care: Part B covers outpatient services received at hospitals, including surgeries, diagnostic tests, and emergency room visits. It also includes mental health services, outpatient rehabilitation, and certain medications administered in an outpatient setting.
  3. Preventive Services: Part B provides coverage for various preventive services, such as flu shots, screenings for cancer, diabetes, and cardiovascular diseases, as well as counseling for obesity and smoking cessation.
  4. Durable Medical Equipment (DME): Medicare Part B covers medically necessary DME, such as wheelchairs, walkers, oxygen equipment, and prosthetic devices, when prescribed by a healthcare provider.

Costs and Deductibles Associated with Parts A and B: While Medicare Part A coverage is generally provided without a monthly premium for most beneficiaries, there are other costs associated with both Parts A and B:

  1. Part A Costs: Beneficiaries may be responsible for a deductible for each benefit period and coinsurance costs for extended hospital stays.
  2. Part B Costs: Part B requires a monthly premium, which is based on income. There is also an annual deductible that must be met before Medicare coverage begins. Beneficiaries are responsible for coinsurance or copayments for covered services.

Services Not Covered by Parts A and B: While Medicare Parts A and B offer comprehensive coverage, it’s important to be aware of the services not covered:

  1. Long-term Care: Medicare does not typically cover long-term care, such as stays in nursing homes beyond the limited coverage provided by Part A.
  2. Prescription Drugs: Original Medicare (Parts A and B) does not cover most prescription medications. However, coverage for prescription drugs can be obtained through a separate Medicare Part D plan or a Medicare Advantage plan that includes prescription drug coverage.
  3. Routine Dental, Vision, and Hearing Care: Medicare does not cover routine dental, vision, or hearing services, such as dental cleanings, eyeglasses, or hearing aids.

Supplementing Medicare with Medigap Policies

Medigap policies, also known as Medicare Supplement Insurance, are private insurance plans designed to supplement Original Medicare. These policies help fill the gaps in coverage that Medicare Parts A and B may leave behind, providing beneficiaries with additional financial protection and peace of mind.

Explanation of how Medigap policies work alongside Original Medicare

Medigap policies work alongside Original Medicare by covering certain out-of-pocket costs that beneficiaries would otherwise be responsible for. When a person has both Medicare Parts A and B, their Medigap policy helps pay for expenses such as deductibles, copayments, and coinsurance.

Coverage options provided by Medigap plans

Medigap plans offer a range of coverage options, with standardized plans labeled by letters (e.g., Plan A, Plan B, etc.). While all Medigap plans offer the same basic benefits within their respective letter category, coverage may vary. Some plans may cover additional benefits such as skilled nursing facility care, foreign travel emergencies, or Part B excess charges.

Benefits of Medigap policies

The benefits of Medigap policies include financial protection from high out-of-pocket costs, flexibility to see any doctor or specialist who accepts Medicare, and the ability to choose from a variety of standardized plans. Medigap policies provide a predictable and consistent way to budget for healthcare expenses.

In conclusion, Medigap policies offer a valuable opportunity to supplement Original Medicare and enhance healthcare coverage. These policies provide coverage for out-of-pocket costs, offering beneficiaries financial protection and greater access to healthcare services.

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The Advantage of Medicare Advantage Plans

Medicare Advantage plans, also known as Medicare Part C, are an alternative way to receive Medicare benefits. Offered by private insurance companies approved by Medicare, these plans provide all the coverage of Original Medicare (Parts A and B) and may include additional benefits.

Explanation of how Medicare Advantage plans combine Parts A, B, and often Part D

Medicare Advantage plans combine the coverage of Medicare Parts A, B, and often Part D into a single comprehensive plan. Here’s how they work:

  1. Part A Coverage: Medicare Advantage plans include the hospital insurance benefits provided by Medicare Part A. This coverage includes inpatient hospital care, skilled nursing facility care, hospice care, and some home health services.
  2. Part B Coverage: Medicare Advantage plans also cover the medical insurance benefits provided by Medicare Part B. This coverage includes doctor’s visits, preventive care, outpatient services, and medical supplies.
  3. Part D Coverage: Many Medicare Advantage plans also include prescription drug coverage, which is provided by Medicare Part D. This allows beneficiaries to have their medications covered under the same plan.

Benefits and additional services provided by Medicare Advantage plans

Medicare Advantage plans offer several benefits and additional services beyond what Original Medicare provides:

  1. Prescription Drug Coverage: Medicare Advantage plans often include prescription drug coverage, saving beneficiaries from having to enroll in a separate Part D plan. This streamlines coverage and can result in cost savings.
  2. Additional Benefits: Medicare Advantage plans may offer additional benefits that may increase overall healthcare experience and quality of life.
  3. Care Coordination: Medicare Advantage plans often provide care coordination services, ensuring that all aspects of a beneficiary’s healthcare are well-managed. This includes managing referrals to specialists, coordinating different treatments, and creating personalized care plans.

Comparing HMOs, PPOs, and other types of Medicare Advantage plans

Medicare Advantage plans come in different types, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Special Needs Plans (SNPs). Here’s a brief comparison of these plan types:

  1. HMOs: HMOs require beneficiaries to choose a primary care physician (PCP) and obtain referrals to see specialists. They often have a network of healthcare providers, and coverage is typically limited to in-network providers, except in emergency situations.
  2. PPOs: PPOs offer more flexibility in choosing healthcare providers. Beneficiaries can see specialists without referrals and have the option to receive care from out-of-network providers, although at a higher cost.
  3. SNPs: SNPs are designed for individuals with specific health conditions or specialized needs. These plans provide targeted coverage and care coordination tailored to the unique requirements of the eligible population.

In conclusion, Medicare Advantage plans (Part C) provide a comprehensive and convenient alternative to Original Medicare. These plans combine the coverage of Parts A, B, and often Part D, while offering additional benefits and services. Beneficiaries can choose from different plan types, such as HMOs, PPOs, and SNPs, based on their healthcare preferences and needs. Exploring the available options can help individuals find a Medicare Advantage plan that best suits their requirements, providing enhanced coverage and improved access to care.

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Medicare Part D: Prescription Drug Coverage

Medicare Part D is the prescription drug coverage offered by private insurance companies approved by Medicare. This optional benefit helps beneficiaries afford the cost of prescription medications and is available to anyone with Medicare Part A or Part B, as well as those with Medicare Advantage plans (Part C).

Explanation of the “donut hole” coverage gap and how it works

The “donut hole” is a term used to describe a temporary gap in Medicare Part D prescription drug coverage. After a beneficiary reaches a certain spending limit for covered medications, they enter the donut hole. During this phase, they are responsible for a larger portion of their prescription costs until they reach the catastrophic coverage threshold. However, it’s important to note that the coverage gap has been gradually closing under the Affordable Care Act.

How to choose the right Part D plan based on individual prescription needs

When selecting a Medicare Part D plan, it’s essential to consider individual prescription needs. Here are a few steps to guide the decision-making process:

  1. Review Current Medications: Make a list of current prescriptions, including dosages and frequencies. This will help identify the specific medications that need coverage.
  2. Compare Formularies: Each Part D plan has a list of covered medications known as a formulary. Compare formularies to ensure that the plan covers the necessary medications. Look for any restrictions or prior authorization requirements that may affect access to medications.
  3. Network Pharmacies: Check if the plan’s preferred pharmacies are conveniently located and accessible.

Comparing costs and coverage of different Part D plans

To compare costs and coverage, it’s beneficial to use the Medicare Plan Finder tool available on the official Medicare website. This tool allows beneficiaries to enter their prescriptions and compare different Part D plans based on estimated annual costs, coverage details, and pharmacy options. Factors to consider include monthly premiums, annual deductibles, copayments, and coinsurance.

In conclusion, Medicare Part D provides essential prescription drug coverage to Medicare beneficiaries. By understanding the “donut hole” coverage gap, choosing the right plan based on individual prescription needs, and comparing costs and coverage, beneficiaries can make informed decisions to ensure access to necessary medications at an affordable cost. Utilizing online resources, such as the Medicare Plan Finder, can simplify the process and help individuals find the Part D plan that best suits their specific requirements.

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Call a licensed insurance agent (877) 354-4165

To request information without providing personal information, please call the phone number listed above. By completing the quotes form or calling the above number, you can be directed to a licensed insurance agent who can provide more information about your options and answer your questions via a third-party partner of HealthMatchup. Participating sales agencies represent Medicare Advantage HMO, PPO, PFFS organizations that are contracted with Medicare. Enrollment in any plan depends on contract renewal. This is a solicitation for insurance. Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply. We do not offer every plan available in your area.  Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.  Outside of the Medicare Annual Open Enrollment Period, members can enroll in a plan only if they meet certain criteria. A licensed insurance agent can help you determine whether you are eligible.