Introduction to Medicare
Coverage Choices
You have important decisions to make if you’re eligible for Medicare—but you have choices. Learning as much as possible about each option may help you feel more confident about choosing coverage that fits your needs.
Get to know your coverage choices
When looking at coverage choices, there’s a lot to consider. You may enroll in Medicare Part A (hospital insurance), Medicare Part B (medical insurance) or both. Once you enroll in Original Medicare (Parts A & B), you may have other coverage choices, too, such as a Medicare Advantage plan (Part C), a Medicare Prescription Drug plan (Part D) or a Medicare Supplement insurance plan (Medigap).
Choose to add one or both of the following to Original Medicare.
Medicare Prescription Drug (Part D) Plan
Offered by private companies
OR Choose a Medicare Advantage plan.
Medicare coverage choices from the U.S. government
Original Medicare (Parts A & B) is coverage provided by the federal government. It helps pay for hospital stays and doctor visits. But it doesn’t cover everything—and it doesn’t cover prescription drugs. Original Medicare has two parts: Part A and Part B. Let’s learn more.
Medicare Part A: Hospital coverage
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Hospital stays and inpatient care, including:
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Medicare Part B: Medical coverage
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| Part B coverage limits: Preventive services and screenings are covered on set schedules, like a yearly flu shot. Other services and supplies must be medically necessary to diagnose or treat a disease or condition. | |
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| Part B coverage limits: Preventive services and screenings are covered on set schedules, like a yearly flu shot. Other services and supplies must be medically necessary to diagnose or treat a disease or condition. | |
Coverage choices from private insurance companies
[[state-start:AL,AK,AZ,AR,CA,CO,CT,DE,DC,FL,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,MP,NE,NV,NJ,NM,NY,NC,ND,OH,OK,OR,PA,PR,RI,SC,SD,TN,TX,UT,VT,VI,VA,WA,WV,WI,WY]]There are also coverage choices offered by private insurance companies like UnitedHealthcare. These include Medicare Advantage (Part C) plans and Medicare Prescription Drug (Part D) plans, and Medicare Supplement plans. Let's learn more.[[state-end]]
[[state-start:null,AS,NH]] There are also coverage choices offered by private insurance companies like UnitedHealthcare. These include Medicare Advantage (Part C) plans and Medicare Prescription Drug (Part D) plans. Let's learn more.[[state-end]]
Medicare Advantage (Part C) plans: Many benefits, one convenient plan
Medicare Part C is Medicare Advantage. Medicare Advantage plans combine Part A and Part B benefits into one plan. Most also include prescription drug coverage and offer additional benefits not covered by Original Medicare, often with no additional premium.
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Special Needs Plans (SNPs): Medicare Advantage plans designed for specific needs
If you have special health care or financial needs, you may qualify for a Special Needs Plan. All Special Needs Plans include drug coverage. Other benefits may include coordination of care, transportation to and from medical appointments, credits to buy everyday health items, and routine vision and dental coverage. There are four main types of Special Needs Plans:
- Dual-Eligible Special Needs Plans (DSNPs) for people who have both Medicare and Medicaid
- Chronic Special Needs Plans (CSNPs) for people living with severe or disabling chronic conditions
- Institutional Special Needs Plans (ISNPs) for people who live in a skilled nursing facility
- Institutional-Equivalent Special Needs Plans (IESNPs) for people who live in a contracted assisted living facility and need the same kind of care as those who live in a skilled nursing facility
Medicare Prescription Drug (Part D) plans: Get help paying for the prescriptions you take
Medicare Part D is prescription drug coverage. You can get prescription drug coverage with a standalone Part D plan or with a Medicare Advantage plan that includes prescription drug coverage.
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Medicare Supplement insurance plans: Get help paying some out-of-pocket costs
Medicare Supplement insurance, often called "Medigap," helps pay some of the out‑of‑pocket costs not paid by Original Medicare (Parts A and B). There are ten plans standardized by the federal government. Each Medicare Supplement plan offers the same basic benefits no matter which insurance company sells it.
Plan F is also offered as a high-deductible plan by some insurance companies in some states. If you choose this option, this means you must pay for Medicare-covered costs (coinsurance, copayments, deductibles) up to the yearly deductible amount of $2,240 in 2018 before your policy pays anything.
Note: In Massachusetts, Minnesota and Wisconsin, there are different standardized plan options available.
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All Medicare Supplement plans provide these basic benefits:
Some plans also provide additional benefits, including:
NOTE: Benefits and costs vary depending on the plan chosen. |
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* NY: In New York, the Excess Charge is limited to 5%; PA and OH: Note: Under Pennsylvania and Ohio law, a physician may not charge or collect fees from Medicare patients which exceed the Medicare-approved Part B charge. Plans F and G pay benefits for excess charges when services are rendered in a jurisdiction not having a balance billing law; TX: In Texas, the amount cannot exceed 15% over the Medicare- approved amount or any other charge limitation established by the Medicare program or state law. Note that the limiting charge applies only to certain services and does not apply to some supplies and durable medical equipment; VT: Vermont law generally prohibits a physician from charging more than the Medicare-approved amount. However, there are exceptions and this prohibition may not apply if you receive services out of state. **Care needed immediately because of an injury or an illness of sudden and unexpected onset. Benefit is 80% and beneficiaries are responsible for 20% after the $250 annual deductible with a $50,000 lifetime maximum for medically necessary emergency care received outside the U.S. during the first 60 days of each trip. |
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All Medicare Supplement plans provide these basic benefits:
Some plans also provide additional benefits, including:
NOTE: Benefits and costs vary depending on the plan chosen. |
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* NY: In New York, the Excess Charge is limited to 5%; PA and OH: Note: Under Pennsylvania and Ohio law, a physician may not charge or collect fees from Medicare patients which exceed the Medicare-approved Part B charge. Plans F and G pay benefits for excess charges when services are rendered in a jurisdiction not having a balance billing law; TX: In Texas, the amount cannot exceed 15% over the Medicare- approved amount or any other charge limitation established by the Medicare program or state law. Note that the limiting charge applies only to certain services and does not apply to some supplies and durable medical equipment; VT: Vermont law generally prohibits a physician from charging more than the Medicare-approved amount. However, there are exceptions and this prohibition may not apply if you receive services out of state. **Care needed immediately because of an injury or an illness of sudden and unexpected onset. Benefit is 80% and beneficiaries are responsible for 20% after the $250 annual deductible with a $50,000 lifetime maximum for medically necessary emergency care received outside the U.S. during the first 60 days of each trip. |
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Medicare Advantage (Part C) plans: Many benefits, one convenient plan
Medicare Part C is Medicare Advantage. Medicare Advantage plans combine Part A and Part B benefits into one plan. Most also include prescription drug coverage and offer additional benefits not covered by Original Medicare, often with no additional premium.
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Special Needs Plans (SNPs): Medicare Advantage plans designed for specific needs
If you have special health care or financial needs, you may qualify for a Special Needs Plan. All Special Needs Plans include drug coverage. Other benefits may include coordination of care, transportation to and from medical appointments, credits to buy everyday health items, and routine vision and dental coverage. There are four main types of Special Needs Plans:
- Dual-Eligible Special Needs Plans (DSNPs) for people who have both Medicare and Medicaid
- Chronic Special Needs Plans (CSNPs) for people living with severe or disabling chronic conditions
- Institutional Special Needs Plans (ISNPs) for people who live in a skilled nursing facility
- Institutional-Equivalent Special Needs Plans (IESNPs) for people who live in a contracted assisted living facility and need the same kind of care as those who live in a skilled nursing facility
Medicare Prescription Drug (Part D) plans: Get help paying for the prescriptions you take
Medicare Part D is prescription drug coverage. You can get prescription drug coverage with a standalone Part D plan or with a Medicare Advantage plan that includes prescription drug coverage.
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Choose the right combination for you
Medicare isn't one-size-fits-all. You can combine different coverage choices, offered through the government or private insurance companies, to get the coverage that is a good fit for you. There are 7 different combinations.
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Original Medicare (Parts A and B) or just Part A or just Part B
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Original Medicare (Parts A and B) plus a standalone Prescription Drug (Part D) plan
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Original Medicare (Parts A and B) plus a standalone Prescription Drug (Part D) plan plus a Medicare Supplement plan
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Original Medicare (Parts A and B) plus a Medicare Supplement plan
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A Medicare Advantage (Part C) plan with built-in drug coverage
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A Medicare Advantage (Part C) plan without drug coverage
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A Medicare Advantage (Part C) plan without drug coverage plus a standalone Prescription Drug (Part D) plan
Note: Combination 7 is only available if you choose a Private Fee-For-Service (PFFS) Medicare Advantage plan without drug coverage or a Medicare Savings Account (MSA) plan. These are the only types of Medicare Advantage plans that can be combined with a standalone Medicare Prescription Drug plan.
