Medicare Part A

Hospital care (inpatient)

  • Limited home health services

  • Skilled nursing facility care, provided that custodial care isn’t the only care required

  • Hospice care

Medicare Part B

Diagnostic equipment

  • Doctor visits

  • Lab tests

  • Supplies, such as walkers or wheelchairs

  • Surgeries

  • The Part B premium drops to $164.90 a month

  • You’ll also have an annual deductible of $226

Medicare Part C

Medicare Part C coverage must include at least the same basic services provided by the government under original Medicare. Some of these services include:

  • inpatient hospital stays and treatments

  • limited stays at a skilled nursing facility

  • inpatient rehabilitation

  • limited home healthcare

  • hospice

  • doctor’s visits

  • laboratory tests, blood tests, and X-rays

  • durable medical equipment

  • mental health services

  • emergency ambulance transportation

  • preventive care

In addition to these basic coverage items, many Part C plans offer extras, including:

  • dental

  • vision

  • hearing

  • prescription drugs

  • SilverSneakers membership or gym memberships

  • transportation to doctor’s appointments

  • home meal delivery after an inpatient stay

Medicare Part D

Medicare offers prescription drug coverage (Part D) to everyone with Medicare. Medicare Part D plans are offered by private companies to help cover the cost of prescription drugs. Everyone with Medicare can get this optional coverage to help lower their prescription drug costs. Medicare Part D generally covers both brand-name and generic prescription drugs at participating pharmacies.

Medicare Advantage

Private insurers offering Medicare Advantage plans can offer many different types of plans. These plan types include: 

  • Health Maintenance Organization (HMO) Plans: With HMO plans, you usually must get your care from in-network providers, except for temporary out-of-network dialysis, out-of-network urgent care, and emergency care. You will probably also need a referral to see a specialist if you have an HMO. 

  • Preferred Provider Organization (PPO) Plans: PPO plans are popular with people who like flexibility. Usually, people will pay less to see their in-network providers and specialists and may pay a little more to see out-of-network providers that accept Medicare. In a PPO, most people do not need prior authorization or a referral to see a specialist. PPO plan premiums are often higher than HMO plan premiums. 

  • Private Fee for Service (PFFS) Plans 

  • Special Needs Plans (SNPs) 

  • HMO Point of Service (HMO-POS) and Medicare Medical Savings Account (MSA) Plans 

Plan types vary depending on how you access your healthcare providers and how much you pay in copayments, coinsurance, and premiums. 

Medicare Supplement

Medicare Supplement insurance plans work with Original Medicare (Parts A & B) to help with out-of-pocket costs not covered by Parts A and B. The following are also true about Medicare Supplement insurance plans:
 

  • Predictable costs help you stay ahead of unexpected out-of-pocket expenses.

  • No network restrictions mean you can see any doctor who accepts Medicare patients.

  • You don't need a referral to see a specialist.

  • Coverage goes with you anywhere you travel in the U.S.

  • There is a range of plans available to fit your health needs and budget goals.

  • Purchasing a Medigap plan and a Medicare Part D prescription drug plan could give you more complete coverage.

  • Guaranteed coverage for life† means your plan can't be canceled.

Why Choose a Medicare Plan?

Under original Medicare, the federal government sets the premiums, deductibles and coinsurance amounts for Part A (hospitalizations) and Part B (physician and outpatient services). For example, under Part B, beneficiaries are responsible for 20 percent of a doctor visit or lab test bill. The government also sets maximum deductible rates for the Part D prescription drug program, although premiums and copays vary by plan. Many beneficiaries who elect original Medicare also purchase a supplemental – or Medigap – policy to help defray many out-of-pocket costs, which Medicare officials estimate could run in the thousands of dollars each year. There is no annual cap on out-of-pocket costs.

Under Medicare Advantage, enrollees must still pay the government-set annual Part B premium and sometimes an additional premium for the MA plan. But instead of paying the 20 percent coinsurance amount for doctor visits and other Part B services, most MA plans have set copay amounts for a physician visit, and typically that means lower out-of-pocket costs than original Medicare. MA plans also have an annual cap on out-of-pocket expenses.

You should also check if you are eligible for Medicaid or any of the other assistance programs Medicare offers to low-income enrollees.