Medicare Summary Chart
The best way I can present a brief summary of Medicare in My Medicare Search in is by viewing a simple chart that breaks out the major pieces.
You are eligible for Part A of your original Medicare when you turn 65 or whenever you receive your Medicare card.
If you have also enrolled in Part B, which is indicated on your Medicare card, you have both Part A and Part B Medicare insurance.
Let’s look below at the Left side of this chart, Original Medicare.
Left Side of the Chart
Original Medicare
Part A hospital insurance is automatically covered under original Medicare. Part B medical insurance is an option you have, but you must pay a Part B premium each month. This part B premium (I also call it a Part B Premium Tax because everyone with Part G must pay this “Premium Tax.”
Part B premium can be deducted from your Social Security payments or separately billed to you. Most people sign up for part B medical insurance benefits when they turn 65. If you do not sign up for part B unless you’re covered under a qualified Medicare plan through a group policy from your employer and later decide to sign up for part B, you will most likely incur a penalty, which would be an additional charge to your part B premium.
So, if you choose to keep your original Medicare benefit with Part A and Part B, you will be covered approximately 80% (based on average) of your healthcare costs except for prescription drugs.
Prescription drug coverage, private insurance plans, and Medicare Part D Prescription Drug Plans are available from private insurance companies with a monthly premium. You will only have prescription coverage with this separate private insurance Part D Prescription Drug Plan. Note: Private Internet and pharmacy plans also provide discounts on prescription retail prices. However, I recommend a Part D Prescription Drug Plan as a better way to do the same on prescriptions.
Continuing on the left side of the original Medicare, you have one more option. That option is to add a Medicare Supplement Insurance (Medigap) Policy from a private insurance company. This is not part of Original Medicare but is in addition to Original Medicare furnished by private insurance companies. Both Part D Medicare Prescription Drug plans and Medicare Medigap Supplement Insurance policies are provided by private insurance companies.
Compare Medigap Plans
Medigap (Supplement) policies are standardized.
Every Medigap policy must follow federal and state laws designed to protect you and be identified as “Medicare Supplement Insurance.” Insurance companies can sell you only a “standardized” policy identified by letters in most states.
Every policy, regardless of the insurer, has the same coverage. However, some policies provide additional benefits that may vary by insurance company.
Each insurance company decides which Medigap policies it wants to sell, although state laws might affect which ones they offer. Insurance companies that sell Medigap policies:
- Don’t have to offer every Medigap plan
- Must offer Medigap Plan A if they offer any Medigap policy
- Must also offer Plan C or Plan F if they offer any plan
Medigap plans are “Pay Upfront” for services, meaning they have a monthly premium that must be paid. This differs from Medicare Advantage Plans (covered later), typically Pay-As-You-Go plans with little or no monthly premium payments.
Medigap Plan Comparison Chart
The chart below is a comparison of Medigap policies
Yes = covered expense
No = expense not covered
% = percentage of the cost covered
Out-of-pocket = Annual amount you must pay before the policy pays
| Medigap Benefits | Supplement (Medigap) Plans | |||||||||
| A | B | C | D | F* | G* | K | L | M | N | |
| Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up. (You might pay a premium if you only have 39 quarters or less in Medicare taxes) | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| Part B coinsurance or copayment | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes*** |
| Blood (first 3 pints) | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Part A hospice care coinsurance or copayment | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Skilled nursing facility care coinsurance | No | No | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Part A deductible $1,676 | No | Yes | Yes | Yes | Yes | Yes | 50% | 75% | 50% | Yes |
| Part B deductible $257.00 | No | No | Yes | No | Yes | No | No | No | No | No |
| Part B excess charge | No | No | No | No | Yes | Yes | No | No | No | No |
| Foreign travel exchange (up to plan limits) | No | No | 80% | 80% | 80% | 80% | No | No | 80% | 80% |
| Out-of-pocket limit** | N/A | N/A | N/A | N/A | N/A | N/A | $7,060 | $3,530 | N/A | N/A |
| * Plans F and G also offer a high-deductible plan in some states. With this option, you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible before your policy pays anything. (Plans C and F aren’t available to people who were newly eligible for Medicare on or after January 1, 2020.) | ||||||||||
| ** For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year. | ||||||||||
| *** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in inpatient admission. | ||||||||||
Starting January 1, 2020, Medigap plans sold to new people with Medicare won’t be allowed to cover the Part B deductible. Because of this, Plans C and F will no longer be available to people new to Medicare starting on January 1, 2020. If you already have either of these 2 plans (or the high deductible version of Plan F) or are covered by one of these plans before January 1, 2020, you’ll be able to keep your plan. If you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy one of these plans.
Medicare Advantage Plans
RIGHT SIDE OF THE CHART
For many Medicare clients, an Advantage Plan might be a better option.
When you choose an Advantage plan, you leave the Government’s Original Medicare plan for an Advantage Plan that private insurance companies finance. You must have both PART A and PART B to apply for a Medicare Advantage Plan. The private insurance company receives from the government a portion of all of your premium for your Advantage Plan. In many cases, your monthly Advantage Plan premium is very low, and you may even have to pay a zero premium.
One other point about Advantage plans. Most plans include prescription drug coverage. However, some plans do not cover prescription drugs. Therefore, you may want to enroll in a Medicare Advantage Prescription Drug plan (MA-PD).
If you have a qualified prescription plan, such as Military health coverage, you may only want to purchase a Medicare Advantage plan without prescription coverage. This gives you access to Part B (doctors, etc) and benefits outside your existing health plan. However, if your prescription plan is not qualified (such as with an employer health plan), I recommend you purchase a Medicare Advantage plan with prescription coverage to avoid a Par D penalty. Before making any of these moves, could you talk with a current health coverage plan representative? I also suggest you call me to talk about it more.
You must also have Part B coverage, including prescription drug coverage, in a Medicare Advantage plan. When prescriptions are not included in an Advantage plan, and you want prescription coverage, you must purchase a separate Part D Prescription Drug Plan. This is optional. You are not required to purchase a Part D plan; you can only do so if you want prescription coverage.
Remember, most Advantage plans include prescription drug coverage. Make sure the plan you are considering includes this coverage.
If you are still confused, please complete the request form below or telephone me at my cell phone (561) 559-7153 — or fill out the information to start your search with my assistance.