What are the Different Types of Medicare Plans?

Types of Medicare: An Overview of Parts A, B, C, and D

One of the first things to understand when figuring out how Medicare can get you covered for all of your healthcare needs is a basic component of this program: the types of Medicare that are available. Some work together to cover your medical costs, while others stand alone as an alternative to get coverage from a private insurer rather than directly through Medicare. Let’s get started by going over the Medicare options and types of Medicare coverage:

• Medicare Part A: This is hospital insurance that will cover inpatient hospital stays as well as hospice or skilled nursing facility care and some home healthcare services.
• Medicare Part B: This medical insurance, which together with Medicare Part A forms Original Medicare, covers things like doctor visits, preventative services, and outpatient care.
• Medicare Part C: Also known as Medicare Advantage, these plans are offered by private insurers and provide all the benefits of Parts A and B and often include additional coverage, such as prescription drugs or vision and dental.
• Medicare Part D: Another product available from private insurers, this helps pay for prescription medications.
• Medicare Supplement Insurance: Also known as Medigap, these plans offered by private insurers can help you cover out-of-pocket costs not covered by Medicare — things like co-payments, coinsurance, and deductibles.

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Understanding Medicare Part A — Hospital Insurance

Medicare Part A is a major part of Original Medicare (the combination of Medicare Parts A and B), and it can be a crucial part of your Medicare options. Let’s explore Part A in more depth and explain why it’s an important part of the Medicare plan types.

At its simplest, Medicare Part A is your hospital insurance and it will cover inpatient hospital stays if you need to be admitted to the hospital — which can be a big expense if you need surgery, treatment, or special care.

Part A will also cover skilled nursing facility care if the stay is medically necessary and follows a hospital stay of at least three days. Another important benefit is it will cover hospice care at home or in a hospice facility for people who are terminally ill with six months or less to live.

Another possible coverage area of Medicare Part A is home healthcare — think things like part-time or intermittent skilled nursing care, physical therapy, speech-language therapy, or occupational therapy. Just keep in mind that the services need to be ordered by a doctor and provided by a Medicare-certified home health agency.

Medicare Part A is available at no cost to people who are 65 or older and have paid Medicare taxes for at least 10 years, or 40 quarters, during their working years. For those who don’t meet that requirement, they may have to pay monthly premiums for Part A. Deductibles are also possible for each benefit period, as are coinsurances for hospital stays over 60 days and for each lifetime reserve day used.

Medicare Part B — Medical Insurance Type Explained

Medicare Part B is the other half of Original Medicare, and at its simplest, this is your medical insurance. This will cover services and supplies necessary for your treatment or prevention of medical conditions — including outpatient services like doctor’s visits, lab tests, X-rays, mental health services, ambulance services, and preventive services (screenings, vaccines, wellness visits, and more).

Part B will also cover durable medical equipment, including wheelchairs, walkers, and home oxygen equipment when they’re deemed necessary by your healthcare provider.

You’re typically eligible for Medicare Part B if you are a U.S. citizen or permanent resident 65 or older. However, you could be eligible at a younger age if you have certain disabilities or have End-Stage Renal Disease or Amyotrophic Lateral Sclerosis (ALS).

Seniors often have unique financial considerations, including the need for a grocery allowance to maintain a balanced diet. However, it’s crucial to understand the costs associated with healthcare, such as Medicare Part B coverage.

Medicare Part B coverage often carries a standard monthly premium that can change each year and can be higher if your income is above a certain amount. In addition to the premium, Part B has an annual deductible. After meeting the deductible, you’ll typically pay 20% of the Medicare-approved amount for most doctor’s services, outpatient therapy, and medical equipment.

It’s important to note that under some circumstances, you may qualify for programs to help cover your Medicare Part B costs. These programs can provide financial assistance to seniors, ensuring that healthcare expenses are manageable while allowing for essential grocery allowances for seniors. If you’re a senior considering Medicare Part B, it’s advisable to explore these assistance programs to help you maintain a healthy lifestyle while managing your healthcare costs.

Medicare Part C — Medicare Advantage Plans

For many people considering their options for types of Medicare, there’s another important group of Medicare plan types that can be their best option: Medicare Advantage, or Medicare Part C, plans. Think of this as an all-in-one approach to Medicare provided by a private insurance company that is approved by Medicare.

It’ll take the place of and provide the benefits of Medicare Parts A and B, but what really sets Medicare Advantage apart is the extra benefits that are possible — things like vision, hearing, dental, and wellness programs, as well as prescription drug coverage.

While Original Medicare provides coverage directly from the federal government, Medicare Advantage is offered through private insurers. This means the cost, coverage, and rules can vary by plan. However, all Medicare Advantage Plans are required to cover, at a minimum, all the services that Original Medicare covers (excluding hospice care which is still covered by Part A).

When considering Medicare Advantage, there are a few things to bear in mind. First, you need to be enrolled in Medicare Part A and Part B to join a Medicare Advantage Plan. Second, while some Medicare Advantage Plans have premiums as low as $0, you still need to continue paying your Part B premium. Also, each Medicare Advantage Plan can charge different out-of-pocket costs and can have different rules for how you get services.

Another consideration is the network of doctors and healthcare providers. Many Medicare Advantage Plans are either Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs), and you may need to use healthcare providers within the plan’s network for the lowest costs.

The Role of Medicare Part D — Prescription Drug Coverage

For many people wondering what are Medicare options, a Medicare Part D plan could be an important way to minimize their potential for high out-of-pocket medication costs.

A Medicare Part D plan is another product from a private insurer, but this set of Medicare plan types exclusively focuses on adding prescription drug coverage. You’re eligible if you’re enrolled in Medicare Parts A or B, or if you have a Medicare Advantage plan that doesn’t include prescription coverage.

But you’ll want to pay special attention to your Medicare Part D options because each plan has a formulary, or list of covered drugs, and some plans could have “tiers” to assign different cost levels to different types of drugs. Costs could also depend on the pharmacy you use and if you receive Extra Help from Medicare to pay for your prescription costs. Generally, you can expect to pay a monthly premium, a yearly deductible, and co-payments or coinsurance.

You’ll also want to get to know the plan’s specifics when it comes to the so-called “Donut Hole,” which is a temporary limit on what your drug plan will cover. In 2023, once you and your plan have spent $4,430 on covered drugs, you’re in the coverage gap and during this period, you’ll pay no more than 25% of the cost for your drugs. Once your out-of-pocket costs reach $7,050, you’re out of the coverage gap.

Other Medicare Type Options — Medigap, PACE, and More

Medicare Parts A, B, C, and D represent the most typical Medicare plan types, but there are other types of Medicare coverage that could be available to you in certain situations. Let’s look at those other Medicare plan types now: 

• Medigap: Also known as Medicare Supplement Insurance, this private insurance will help pay for some healthcare costs that aren’t covered by Original Medicare (Parts A and B), such as deductibles, co-payments, and healthcare if you travel outside of the U.S. Medigap policies don’t work with a Medicare Advantage plan, so you can’t get a Medigap policy in this case unless you’re switching back to Original Medicare.
• PACE: Programs of All-Inclusive Care for the Elderly, or PACE, are a Medicare and Medicaid program to provide community-based care and services to people who would otherwise need care in a nursing home. If you’re eligible for PACE, which requires you to be 55 or older, to live in the service area of a PACE organization, and be certified as eligible for nursing home care by the appropriate state agency, PACE can provide wide coverage for things like primary care, hospital care, prescription drugs, and long-term services and supports.
• Specialized Plans: There are some other Medicare plan types to know about, such as Medicare-Medicaid Plans and Medicare Special Needs Plans (SNPs), which are a type of Medicare Advantage plan that offers focused and specialized healthcare for specific groups of people. This might include groups like people who have both Medicare and Medicaid, those who live in a nursing home, or people with certain chronic medical conditions.

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Choosing the Right Medicare Plan Types for Your Needs

Now that you understand the types of Medicare and have a handle on the types of Medicare coverage to consider, you might be wondering how to choose the right plan types for your needs. Here are some general rules of thumb that can help you make the right choices for your personal needs:

1. Understand your healthcare needs: List your current and potential future health needs, keeping in mind things like routine health services, primary care visits, and prescription medications.
2. Compare coverage options: Understand the differences between all types of Medicare, and use this knowledge to help determine which plan best suits your needs.
3. Consider your budget: Medicare plan types carry different potential out-of-pocket costs and regular monthly premiums, so keep this in mind as you make your decisions. Original Medicare, for example, often will have lower monthly premiums but potentially higher out-of-pocket costs than a Medicare Advantage plan.
4. Review provider networks: Make sure your plan’s network, especially for a Medicare Advantage plan, includes your preferred healthcare providers or facilities.
5. Consider prescription coverage: Enrolling in Medicare Part D or a Medicare Advantage plan that includes drug coverage can be important for people who take prescription medications.
6. Look into other benefits: Medicare Advantage plans will provide the same benefits as Original Medicare but also will frequently include other things, like vision, dental, and hearing coverage. If those services are important to you, consider a plan that will include those benefits.
7. Get help and advice: Remember that you don’t have to figure this all out alone, and the Health Plus Life team can help you go over all of your options and choose the best plan or plans for your healthcare needs. We’re always available to work with you on this important decision.

Frequently Asked Questions About Types of Medicare:

What are the primary differences between Medicare Parts A and B?

Medicare Part A primarily covers hospital insurance and provides coverage for inpatient hospital stays, skilled nursing facility stays, some home health visits, and hospice care. Medicare Part B, on the other hand, covers outpatient services, including doctor visits, preventive screenings, outpatient hospital care, and some home health visits.

How does Medicare Part C (Medicare Advantage) differ from traditional Medicare?

Medicare Part C, also known as Medicare Advantage, is an alternative to Original Medicare (Parts A and B). These are private plans that cover everything Parts A and B do, but often include additional benefits like dental, vision, and prescription drug coverage (Part D). Medicare Advantage plans may also have network restrictions, meaning you must use the plan’s network of healthcare providers for your care.

What types of prescription drugs are covered under Medicare Part D?

Medicare Part D covers prescription drugs. Each Part D plan has its own list of covered drugs, or formulary, but they all must cover certain types of drugs, including most vaccines and many common types of prescriptions like antidepressants and cancer drugs.

Can I combine different Medicare plan types?

Yes, to some extent. For example, if you enroll in Original Medicare (Parts A and B), you can also enroll in a Medicare Part D plan for prescription drug coverage and a Medigap plan for supplemental coverage. However, if you choose a Medicare Advantage plan (Part C), it often includes Part D coverage and you cannot buy a Medigap plan.

What are Medigap policies, and how do they work with Medicare?

Medigap policies, also known as Medicare Supplement Insurance, are policies sold by private companies to help cover some of the costs not covered by Original Medicare, like copayments, coinsurance, and deductibles. Medigap plans work alongside Original Medicare, but they cannot be used with Medicare Advantage plans.

How can I determine which Medicare plan is best for me?

Determining the best Medicare plan for you involves considering your health needs, budget, and preferences. You should consider the costs, coverage, and network restrictions of each plan. Free resources like the State Health Insurance Assistance Programs (SHIPs) can provide personalized assistance.

Are there specific Medicare options for chronic illnesses or disabilities?

Yes, certain Medicare Advantage plans, called Special Needs Plans (SNPs), are designed specifically for people with certain chronic conditions or disabilities. Also, individuals with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS) have specific enrollment considerations.

Where can I get personalized assistance in choosing a Medicare plan?

There are several resources to get personalized assistance in choosing a Medicare plan. One of the best is the State Health Insurance Assistance Programs (SHIPs), which provide free, personalized counseling for Medicare beneficiaries. You can also use the Medicare Plan Finder tool on Medicare.gov or speak with a trusted insurance agent or broker. The team at Health Plus Life is always available to help you figure out your Medicare options and choose the right Medicare plans.