Original Medicare (Part A and Part B) does not cover everything. It provides basic coverage, but there will be gaps in the coverage. You should expect to be responsible for a portion of your health care costs, including deductibles and coinsurance. This is why many people enroll in additional coverage options that help pay for costs and benefits not covered by Original Medicare. These options include Part C – Medicare Advantage plans and Medigap – Medicare Supplement plans.

Part A - Hospital Insurance

Provided by Federal Government
Coverage: Covers hospital and skilled nursing facility stays, home health care.
Deductible: Yes
Coinsurance: Yes
Premium: Most will not pay a premium

Part B - Medical Insurance

Provided by Federal Government
Coverage: Covers outpatient care, doctor services, physical and occupational therapy, mental health services, preventive care.
Deductible: Yes (Except for preventive services)
Coinsurance: Yes (20% or more of services)
Premium: Yes, monthly, dependent on adjusted gross income

Part C - Medicare Advantage

Provided by private health plans approved by Medicare
Coverage: Combines Part A and Part B and usually Part D. It generally offers extra benefits beyond Original Medicare.
Deductible: Varies by plan. ($0 deductible options may be available)
Coinsurance: Varies by plan
Premium: Yes. $0 premium options may be available.

Part D - Prescription Drug Coverage

Provided by private health plans approved by Medicare
Coverage: Covers prescription drugs.
Deductible: Varies by plan.
Coinsurance: Varies by plan
Premium: Yes, if bought separately; often combined with medicare Advantage Plans.

Medicare Supplement (Medigap)

Provided by private health insurance companies
Coverage: May cover Part A and Part B cost sharing (deductible and coinsurance) for Original Medicare covered services.
Deductible: Varies by plan.
Coinsurance: Varies by plan
Premium: Yes, monthly.

Original Medicare Costs Explained Further

Part A Deductible: If you only have Original Medicare (the red, white and blue card), you will have to pay your Part A deductible if you are admitted to a hospital or skilled nursing facility.

Solution: A Medicare Advantage or Medicare Supplement plan may cover this deductible.

Part B Deductible: If you only have Original Medicare, you will have to pay your Part B deductible when you use your Original Medicare card for outpatient services, such as doctors’ visits, labs, X-rays, etc.

Solution: A Medicare Advantage or Medicare Supplement plan may cover this deductible.

Part B Coinsurance and Copayments: If you only have Original Medicare, you will be responsible for 20% of the Medicare-approved amount of all medical bills after your Part B deductible is met.

Solution: Medicare Supplement plans typically pay for this cost. Medicare Advantage plans carry their own copayments, which can be less expensive than the 20% of the cost of a medical bill (i.e., $15 copay for a doctor visit vs. 20% of the total bill amount).

Premiums: Original Medicare charges a monthly Part B premium, which is calculated based on your adjusted gross income. It is important to know that, if you choose a Medicare Advantage or a Medicare Supplement plan, you must continue to pay your Medicare Part B premium in addition to the premium for the Medicare Advantage or Medicare Supplement plan.

Medicare Advantage

Medicare Part C is more commonly referred to as Medicare Advantage. Medicare Advantage plans are health plans approved by Medicare and run by private companies like Health New England.

Medicare Advantage plans have to:

• Cover everything that Medicare Part A and Part B would have covered
• May cover services that Original Medicare wouldn’t cover:
  • Additional benefits such as vision, hearing, dental, or health and wellness programs
• May be offered with or without Part D

There are several types of Part C plans: HMO, HMO-POS, PPO, SNP, PFFS plans.

More about Medicare Advantage – Part C plans

• Similar to employer group plans
• Set network of providers
• Set monthly premium (must continue to pay Part B premium)
• Set copays/cost-sharing when you use services (pay as you go)
• Yearly out-of-pocket maximums
• Pharmacy coverage (Part D) is generally built into the plan
• May offer additional benefits beyond Original Medicare such as dental, fitness, weight watchers, vision, hearing, etc.
• May offer emergency coverage when traveling worldwide
• Ease of use
• Variety of plans to choose from
• Can change plans yearly during the Annual Enrollment Period

Medicare Supplement

Medigap insurance plans are also known as Medicare Supplement plans.

• There are three Medicare Supplement Plans offered in Massachusetts:
  • Medicare Supplement Core
  • Medicare Supplement 1
  • Medicare Supplement 1A
• All Massachusetts Medicare Supplement plans cover the same set of core benefits
• The differences between the two Medicare Supplement plans are:
  • Premium cost
  • Premium discount when newly eligible
  • Additional benefits: like fitness coverage, foreign travel

More about Medicare Supplement – Medigap plans

• You are covered nationwide (US and US territories) and will be accepted by any Medicare approved facility or health care provider
• Not covered outside of US or US territories
• Only cover what Original Medicare covers
• Fills in the gaps to Original Medicare
• May be responsible for Part A and Part B deductibles and coinsurance – depending on which Medicare Supplement plan you choose
• Does not include Part D drug coverage – must purchase separately
• May not include additional benefits such as dental, hearing, vision, fitness, etc.
• Guaranteed renewable as long as you pay your premium
• Can switch Medicare Supplement plans anytime during the year

Original Medicare is the federal health insurance program for people who are age 65 or older and for people younger than 65 with certain disabilities. Original Medicare helps to cover the cost of hospital and medical expenses. Original Medicare includes Part A (Hospital Insurance) and Part B (Medical Insurance). When you sign up for Original Medicare, you receive coverage over your lifetime as long as you pay your monthly premium.

With Original Medicare, you may be responsible for deductibles, coinsurance and copayments, and will have limitations on what is covered. For instance, routine vision, dental, hearing and prescription drugs may not be covered.

Original Medicare only provides basic coverage, there will be gaps in coverage and you will be responsible for a portion of your health care costs. This is why many people enroll in additional coverage that help pay for costs and benefits not covered by Original Medicare.

To learn more about Medicare, visit medicare.gov.

Medicare Advantage is provided by private health plans approved by Medicare. These plans combine Part A and Part B, and usually Part D (prescription drug coverage). Medicare Advantage plans may provide coverage and benefits beyond those covered by Original Medicare, such as an annual physical, dental and fitness allowances, and health and safety items. This type of plan is also known as Part C.

Medicare Supplement (Medigap) is provided by private health insurance companies. These plans help to cover Part A and Part B cost-sharing amounts, such as deductibles and coinsurance, for Original Medicare covered services. Separate prescription drug coverage must be purchased.

Original Medicare does not provide prescription drug coverage. You must buy separate Part D prescription drug coverage if you have Original Medicare or a Medicare Supplement plan. Part D prescription drug plans help pay for the cost of prescription drugs and are sold through private companies.

Solution: If you want prescription drug coverage, there are two ways to get a Part D plan. You can purchase a Medicare Advantage plan with drug coverage (MAPD) or a stand-alone Prescription Drug Plan (PDP).

You may not be enrolled in a stand-alone PDP and also be enrolled in a Medicare Advantage Plan at the same time.*

*Exceptions: Medical Savings Account (MSA), Private Fee-for-Service (PFFS) or Cost Plans

Offered by private health plans. Medicare Advantage plans combine Part A and Part B and may offer additional benefits such as dental, hearing vision and prescription drug (Part D) coverage.

Medicare Part A and Part B for covered benefits, with Medigap supplementing coverage for Medicare-approved services.