Overview

Medicare is a huge help for more than 65 million older individuals, giving crucial healthcare coverage to people who are 65 and up, some people with disabilities, and those under 65 with end-stage renal disease (ESRD). Think of it as a safety net for a lot of people who need medical care.

The basic Medicare package, which includes Part A (hospital insurance) and Part B (medical insurance), doesn’t cover everything. There are some gaps, like certain treatments or services that you might need but aren’t included. That’s where Medicare Supplement (also known as Medigap) or Medicare Advantage (Part C) plans come into play. They can help cover those extra costs that Original Medicare doesn’t, making sure you’re more fully protected.

Original Medicare Part A (Hospital Insurance) 

• Inpatient care in hospitals 
• Skilled nursing facility care 
• Hospice care 
• Home health care

Original Medicare Part B (Medical Insurance) 

• Services from doctors and other healthcare providers 
• Outpatient care 
• Home health care 
• Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment) 
• Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits) 

Additional benefits are available privately-ran Medicare Advantage (Part C), Medicare Part D (Prescription Drug Plans), and Medicare Supplement (also known as Medigap).

Eligibility:

•  If you’re 65 or older, a U.S. citizen or permanent resident, have specific disabilities or suffer from ESRD under the age of 65, you’re eligible for Medicare. 

Plan Costs: 

• Prices can be different. Part A might not cost anything for many people, but you might have to pay some money upfront and a part of the bill. Part B has a monthly cost or premium, and you’ll also need to pay some money upfront and a part of the bill too.
  • Part B’s monthly premium is $174.70 in 2024.

How to Enroll:

•  Sign up during the seven-month Initial Enrollment Period around your 65th birthday or during the annual Open Enrollment from October 15 to December 7.

Medicare Plan Options

Below, are some additional Medicare plan options to supplement your Orginal Medicare (Part A and Part B coverage).

Medicare Advantage

Medicare Advantage plans, also known as Part C, are offered by private health insurance companies. These plans provide additional benefits beyond Original Medicare (Part A and Part B).

These benefits include coverage for:

• Dental/Vision 
• Inpatient hospital and skilled nursing facility care
• Emergency and urgent care
• Doctor visits, surgery, preventive care,
• Medical equipment like wheelchairs and, walkers, and more.

Additional plan benefits may also include:

• Dental/Vision or;
• Grocery benefits or;
• Gym Memberships

Enrollment Information

To enroll in a Medicare Advantage plan, you first need to sign up for Original Medicare by enrolling in Parts A and B. If you need help getting started, refer to our “What is Medicare?” guide for detailed information.

After enrolling in Original Medicare, you can select a Medicare Advantage plan. Healthcare.com’s plan selector tool simplifies this process.

There are specific enrollment periods each year when you can make changes to your plan:

• Annual Medicare Enrollment Period: October 15 through December 7.
• Medicare Advantage Open Enrollment Period: January 1 through March 31.

Costs

Medicare Advantage enrollees typically pay a monthly premium, averaging around $18.50 in 2024. Additionally, plans may include copays and deductibles, with an annual out-of-pocket maximum of $8,850. Once you reach this limit, your Medicare Advantage plan covers the remaining costs for the year.

Medicare Supplement

Medigap, also known as Medicare Supplement insurance, is designed to help cover the gaps left by Original Medicare (Parts A and B). Unlike Medicare Advantage plans, Medigap plans offer additional coverage to reduce out-of-pocket expenses not covered by Original Medicare.

Benefits include:

● Coverage outside of the United States (international travel)

● Partial coverage for part A and B coinsurance/out-of-pocket costs

● Access to more doctors

Understanding Medigap Plans

Medigap plans are identified by letters: A, B, C, D, F, G, K, L, M, and N. Each plan offers different levels of coverage for various healthcare costs, including:

– Medicare Part A Coinsurance and Hospital Costs

– Medicare Part B Coinsurance and Copayments

– Blood (up to three pints)

– Part A Hospice Care Coinsurance and Copayments

– Skilled Nursing Facility Care Coinsurance

– Part A Deductible

– Part B Deductible

– Part B Excess Charges

– Foreign Travel Emergency (limited coverage)

These plans can cover up to 20% of medical expenses not addressed by Original Medicare, giving you greater financial security.

How to Enroll

You can enroll in a Medigap plan during your initial 7-month Medigap Open Enrollment Period without facing penalties or undergoing medical underwriting. After signing up for Original Medicare, use Healthcare.com’s plan selector to compare and choose the best Medigap plan for your needs.

Cost of Medigap Plans

Monthly premiums for Medigap policies vary based on the plan type, insurer, location, gender, and age. For example, Plan G, a popular choice, generally costs between $100 and $300 per month. 

It’s crucial to understand your potential out-of-pocket costs for care that Medicare doesn’t cover. All Medigap plans cover Medicare Part B coinsurance, and many plans cover other benefits at 100%, reducing your out-of-pocket expenses.