Medicare is a health insurance program people over 65, people under 65 with certain disabilities and people of all ages with End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig's disease).
Part A (Hospital Insurance): helps cover some of the costs of inpatient care in hospitals including critical access hospitals and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice and some home health care. Beneficiaries must meet certain conditions to get these benefits. Some beneficiaries have to pay a Premium for Part A.
Part B (Medical Insurance): helps cover doctors' services, outpatient services, certain home health services, durable medical equipment and other services that Part A might not cover. Each year, the Part B premium, deductible and coinsurance rates are determined according to provisions of the Social Security Act. In 2025, the standard monthly premium is $185 and the annual deductible is $257. There are Income-Related Monthly Adjustment Amounts (IRMAA) for high-income beneficiaries. You can visit CMS.gov or Medicare.gov for the IRMAA brackets.
Part C (Medicare Advantage or MA): Insurance plans provided by private insurance companies that are required to cover all the benefits of Medicare Parts A & B. Most plans offer additional coverage to include Part D, dental, vision and hearing. You'll need to decide if a MA plan or Medicare Supplemental Plan (Medigap) plan will be best for you!
Part D (Drug Coverage): Can be included in some Medicare Advantage Plans or may need to be purchased separately. Medicare Supplemental plans generally don't include drug coverage so a Part D plan will need to be purchased. Part D plans are offered by private insurance companies for a monthly premium. If a beneficiary doesn't enroll in a Part D plan when they are first eligible, there will be penalties imposed on their monthly Part D premium for the rest of their life! Yes, even if you're not prescribed any medication. If you have creditable Part D coverage through an employer or union, you can delay a Part D plan until such time you lose creditable coverage.
A Medicare Supplement (Medigap) insurance, sold by private companies, can help pay some of the health care costs that Original Medicare (Parts A & B) doesn't cover, like co-payments, coinsurance, and deductibles.
If you have Original Medicare and you buy a Medicare Supplemental policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs and the supplement plan will fill in some of the gaps. Hence the word "Medigap".
You'll need to decide if a Medicare Advantage Plan or a Medicare Supplemental will be best for you.
Health Maintenance Organization (HMO) Plan
In most HMO Plans, you can only go to doctors, other health care providers, or hospitals in the Plan's network. Some exceptions may apply in emergency situations. You may need to get a referral from your primary care doctor to see other doctors or specialists.
Preferred Provider Organization (PPO) Plans
In a PPO Plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. You pay more if you use doctors, hospitals, and providers outside of the network. Referrals from a Primary Care Physician (PCP) may not be necessary.
Private Fee-for-Service (PFFS) Plans
PFFS plans aren’t the same as Original Medicare or Medicare supplement. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.
Special Needs Plans (SNP)
Medicare SNPs are a type of Medicare Advantage Plan that are available to people with certain chronic conditions. They tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the beneficiaries they serve.
To find more in-depth information on these plans, visit the link below.
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Of course there are! Medicare Supplemental Plans have different letters that describe the various standardized coverages as determined by the Centers for Medicare and Medicaid Services. Home - Centers for Medicare & Medicaid Services | CMS Every insurance company must offer the same exact coverage according to the Plan letter. The Medigap link below will highlight the insurance coverage by Plan letter. The price you pay is dependent upon the letter plan that you choose and will vary amongst all insurance companies. Here is where I can help you get the best price by quoting the letter plan that you choose and looking at each company in your service area.
Medicare Advantage Plan pricing varies from $0 monthly premium plans and low-cost monthly premiums which will vary by varies by company. Medicare Advantage Plans will change annually and you have the option to switch plans every year during the Annual Enrollment period. MA plans are not subjected to the beneficiary going through medical underwriting whereas switching Supplemental plans requires medical underwriting, potentially impacting your monthly premium. Generally, beneficiaries who choose a Medicare Supplemental Plan do not change plans since doing so will subject them to medical underwriting. Supplemental Plans monthly premiums generally increase annually.
Absolutely! Most Medicare beneficiaries choose their Medicare Insurance plan according to the cost of the monthly premium. However, consideration should also be placed upon deductibles, coinsurance and maximum out of pocket costs. With Medicare Supplemetnal Plans, you'll know your monthly premium and your payment may increase year over year. Medicare Advantage Plans have Maximum out of pocket that vary per plan. In the event of some illnesses, one might anticipate paying maximum out of pocket per the plan chosen.
Supplemental Plans are defined by letters as you can see in the link below. Each insurance company who offers a Plan N, for example, will offer the same coverage as noted in the chart. The pricing for a Plan N will vary according to the insurance company.
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