Millions of Americans rely on Medicare to cover their routine healthcare as well as any hospital or surgical needs. Millions of Americans also rely on Medicare for dental plans, vision, and prescription coverage. Is the latter really Medicare? Isn’t it a different part altogether? Is it private insurance? As you see, understanding the various parts of Medicare and its supplements can be tough. And when you’re trying to decide what kind of health coverage you need, confusion is the last thing you want. Brush up on your options with this quick explainer.
The Basics: Medicare Parts A & B
Medicare Part A is best described as your standard hospital care insurance. Part A does not require a monthly premium if you qualify (meaning you’ve paid enough through Medicare taxes over your years of working). You’re eligible for premium-free Part A coverage when you turn 65 (or have been on Social Security Disability for two years). Part A typical covers hospital stays (to a point), nursing facility care (but not long-term), hospice, and some home health care.
Medicare Part B is best understood as your more basic, everyday healthcare. It pays part of your doctor visits, outpatient procedures, medical equipment, labs, X-rays, and ambulance services. You don’t have to have Part B if you have this covered from a private insurer. Part B does cost you — it requires a monthly premium, and you must hit a deductible.
Additional Medicare Plans (the Extras): Parts C (Advantage) and D
You can’t get Medicare Parts C or D without first signing up for basic (Parts A or B) Medicare. That’s because, while technically separate plans, they are in practice “add-on” plans.
Medicare Part C is also known as Medicare Advantage. Advantage plans are private health plans, but they must provide at least the same amount and type of coverage that Medicare Parts A and B provide. As MedicareConsumerGuide explains, the types of Advantage plans are provided through “Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medical Savings Account (MSA) plans.”
So why get an Advantage plan? Well, they can sometimes be cheaper. Also, most Advantage plans offer some sort of drug coverage, and many offer extras like dental and vision insurance. If this interests you, take advantage of a Medicare plan finder.
Medicare Part D is solely for prescription medications. You can enroll in it separately if you have A and B, or you can choose not to if your Advantage plan covers the medication you need. Part D plan holders will pay a monthly premium as well as copayments and often deductibles.
What Is Medigap?
You may have heard about Medigap insurance and been lost. What exactly is it? The AARP describes it as your optional backup plan. Medigap can be there for you when other Medicare plans don’t cover what you need. Medigap, which is sold by private insurers, can help with copays and deductibles. There are 11 different Medigap plans available (A-G and K-N). Just think about the name — Medigap helps you fill in the “gaps” in your Medicare coverage.
How to Figure Out Enrollment Periods
Once you know what everything is, the real hard part begins (joking, kind of). Medicare enrollment can be tricky. There is an initial enrollment period followed by open enrollment periods. For a quick guide on enrollment, check here.
For most seniors, Medicare is the best option. It’s often the cheapest plan you can get. It’s also accepted by a majority of providers. And even though all the “parts” can be confusing, it’s one of the more straightforward healthcare systems — at least in terms of benefits and payment.