Understanding the 5 Types of Medicare

An old couple holding hands

When someone says they have Medicare, they might be talking about several plans. Medicare includes a myriad of policy options, and each provides different types of cost assistance. Primarily, there are five types of coverage from which you might benefit. As a result, you’ll have to carefully choose from among your options to come up with the benefits that are best for you. Let’s take a closer look at how each type of coverage can benefit you.

Coverage 1 & Coverage 2: Original Medicare Parts A & B

The United States government implemented the Medicare program more than 50 years ago. Initially, it was a solution for the high costs of medical care that senior citizens face. However, it has grown a lot over the years.


The standard insurance program is commonly called Original Medicare. It consists of two parts: Medicare Part A & Medicare Part B.

Part A Coverage: This is hospital insurance. It covers medical bills the policyholder accumulates while receiving hospital treatment. It can cover the costs of surgeries, inpatient treatments and the related boarding costs. It can also cover the care you receive in nursing homes, skilled nursing facilities, home health care and hospice services.

Part B Coverage: With Medicare Part B, you receive medical insurance you can use for more of your everyday health care costs. For example, your plan might pay for outpatient checkups, vaccinations, mental health treatment and preventive care. Overall, this is the coverage you use to pay for necessary services that help keep you healthy.


Both Part A & Part B coverage have cost sharing requirements for policyholders.

Many people can receive their Part A coverage at a $0 premium.

In 2020, the Part B premium ranges from $144.60 – $491.60 depending on your household’s income and tax filings.

Part A coverage includes a $1,408 deductible. 

There is a $198 deductible for Part B coverage.

Part B requires policyholders to pay a coinsurance at 20% of the Medicare-approved cost of certain treatments.

Part A coinsurance obligations vary based on the number of days you receive inpatient treatment.


To qualify for Original Medicare, most Americans pay payroll taxes throughout their careers. Usually around their 65th birthday, they become eligible to enroll in benefits. Younger individuals (minors included) might also qualify for Original Medicare if they have certain disabilities or end-stage renal disease (ESRD).


Coverage 3: Medicare Part C/Medicare Advantage Coverage


Though Original Medicare can be a great benefit, it does have its limitations, too. For example, it does not cover certain care, notably the costs of most prescription drugs.


One of the ways consumers can rectify this issue is to enroll in Medicare Part C coverage, commonly called Medicare Advantage.


Medicare Advantage coverage are private insurance plans offered by major insurance companies. The government works alongside private insurers to subsidize these plans.


Under a Medicare Advantage plan, you are still a participant in the Medicare program. You will still receive all the benefits provided by Original Medicare Parts A & B. Additionally, your Medicare Advantage coverage will often offer expanded benefits, including:

-Dental Insurance

-Vision Insurance

-Hearing Care Coverage

-Prescription Drug Coverage


Different companies offer different Medicare Advantage plans in different areas. Therefore, a policyholder’s premium can vary based on the plan they select. The amount they pay out of pocket for their health care services will vary, too.

The benefit of a Medicare Advantage plan is that it often offers you more coverage and flexible cost options to better meet your personal needs. However, some individuals might not qualify for these plans. Therefore, work with your insurance agent to determine your eligibility for coverage.


Coverage 4: Medicare Part D Prescription Drug Coverage

Millions of people need to take prescription medication to remain healthy. However, Original Medicare often doesn’t provide adequate coverage for most prescription drugs. Policyholders have the option to enroll in a Medicare Part D prescription drug plan.

Like Part C plans, Part D coverage is also offered by private insurers. However, you cannot have a Part C plan and then buy Part D coverage. You must be a participant in Original Medicare only to be able to buy a Part D plan. Prescription drug plans will include their own premiums and co-payment options.


Coverage 5: Medicare Supplements/MediGap Coverage

Under Original Medicare, you will have to pay certain health care costs on your own. However, if you worry about being able to afford these costs on your own, then you might find a solution if you qualify for a Medicare Supplemental policy, also called Medigap coverage.

A Medigap plan is private coverage that works in conjunction with your Original Medicare to pay for your cost of care. Your Original Medicare will first pay its approved amount for the care you receive. You can then use your MediGap plan to cover some of the remaining costs arising from:

-Deductibles

-Copayments

-Coinsurance

There are many types of Medigap plans, and each will offer different benefits and cost assistance. They also will not cover 100% of your health care costs. Work with your agent to determine the plan that will offer you the best cost assistance for the care you receive most often.

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