Medicare Guidance Made Simple
Choosing Medicare coverage doesn't have to be overwhelming. Whether you're becoming eligible for Medicare for the first time or reviewing your current plan, we're here to help you understand your options and choose coverage that fits your healthcare needs, budget, and lifestyle.
Understanding Medicare
Medicare is a federal health insurance program primarily for:
- People age 65 and older
- Certain individuals under age 65 with qualifying disabilities
- People with End-Stage Renal Disease (ESRD) or ALS
Medicare helps pay for many healthcare expenses, but it doesn't cover every cost. That's why many people choose additional coverage to help reduce out-of-pocket expenses and enhance their benefits.
Original Medicare
Original Medicare consists of two parts that work together to provide hospital and medical coverage.
Part A (Hospital Insurance)
Part A helps cover:
- Inpatient hospital stays
- Skilled nursing facility care
- Hospice care
- Some home health care
Most people don't pay a monthly premium for Part A if they have sufficient work history.
Part B (Medical Insurance)
Part B helps cover:
- Doctor visits
- Preventive services
- Outpatient care
- Lab tests and X-rays
- Durable medical equipment
- Physical therapy
Part B requires a monthly premium and generally pays about 80% of covered medical expenses after you meet the deductible. You are typically responsible for the remaining 20%, and Original Medicare does not include an annual out-of-pocket maximum.
Medicare Supplement (Medigap)
A Medicare Supplement (Medigap) plan works alongside Original Medicare to help pay for costs Medicare doesn't cover.
A Medigap plan can help pay for:
- Deductibles
- Coinsurance
- Copayments
- The remaining 20% not paid by Medicare
How It Works
- You keep Original Medicare.
- Medicare pays its share first.
- Your Medigap plan pays its portion afterward.
Benefits of Medigap
- Freedom to see any doctor or hospital nationwide that accepts Medicare
- No referrals required
- More predictable out-of-pocket costs
- An excellent option for people who travel frequently
Important: Medigap plans do not include prescription drug coverage, so many people also enroll in a separate Medicare Part D prescription drug plan.
Medicare Advantage (Part C)
Medicare Advantage is an alternative way to receive your Medicare benefits through a private insurance company approved by Medicare.
Instead of Original Medicare paying your claims directly, your Medicare Advantage plan administers your Medicare benefits.
Many Medicare Advantage plans include:
- Part A coverage
- Part B coverage
- Prescription drug coverage (Part D)
Many plans also offer additional benefits such as:
- Dental coverage
- Vision care
- Hearing benefits
- Fitness memberships
- Transportation services
- Over-the-counter allowances
Benefits of Medicare Advantage
- Lower monthly premiums (some plans offer a $0 premium in addition to the Part B premium)
- Annual maximum out-of-pocket limit for covered services
- Additional benefits not included with Original Medicare
Things to Consider
- Most plans use HMO or PPO provider networks.
- HMO plans may require referrals.
- Your costs depend on the plan you choose and how often you use healthcare services.
Medicare Supplement vs. Medicare Advantage
Both options offer valuable benefits, but the right choice depends on your healthcare needs and personal preferences.
A Medicare Supplement (Medigap) plan may be a better fit if you:
- Travel frequently or live in multiple states
- Want the flexibility to see any provider that accepts Medicare
- Visit specialists regularly
- Prefer more predictable healthcare costs
A Medicare Advantage plan may be a better fit if you:
- Want lower monthly premiums
- Prefer medical and prescription drug coverage bundled into one plan
- Value extra benefits like dental, vision, hearing, or fitness programs
- Are comfortable using a provider network
Which Medicare Option Is Right for You?
There isn't a one-size-fits-all answer. The best Medicare solution depends on your healthcare needs, budget, preferred doctors, and how you expect to use your coverage.
Comparing available Medicare Advantage and Medigap plans based on premiums, provider networks, prescription drug coverage, and expected out-of-pocket costs can help you make a more informed decision. Our experienced team is here to answer your questions and help you review the options available to you.
Get Personalized Medicare Guidance
Whether you're enrolling in Medicare for the first time or considering additional coverage, we'll help you understand your options and choose a plan with confidence.