Medicare Options Compared
Making the switch to Medicare can be overwhelming
If you are reaching this important milestone in life, the following Medicare Options Chart will help you get started on your way to a smooth transition of healthcare.
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Original Medicare | Medicare Advantage | Medigap | |
Type of Coverage | Provided and managed by Federal Government | Provided and managed by private carriers contracted with Medicare | Sold by private carriers approved by Medicare |
Providers/Referals | Any provider who accepts Medicare Nationwide, no referral needed | Predetermined Network and you may need a referral to see a specialist | Any provider who accepts Medicare Nationwide, no referral needed |
Coverage | Parts A (Hospital) & B (Medical) | Part C (combines A & B into one plan) (replaces your Original Medicare) | Pays 50% to 80%, and in many instances 100% of the costs not covered by Original Medicare* |
Deductibles | For Part A – $1,632** | Varies per carrier, from ZERO to having a separate deductibles for medical care and prescription drugs*** | N/A |
Copays | Beneficiary pays 20% of approved services (after deductible) | National average $20 per doctor visit, $75 for ER or Urgent Care, copays vary for prescriptions based on drug tiers, generics range from $3-$5 | N/A |
Out-of-Pocket Maximums | None | Average can range from ZERO to $8,850**** | Plans K – $7,060 |
Prescription Drugs, Dental, Vision, Hearing | Not part of Original Medicare Parts A & B***** | Some plans include these ancillary benefits | Not covered under Medigap |
Average Premiums | Most people Part A is free, Part B rate is $174.70 in 2024****** | Each company sets its own rates Average of $25 + Part B standard rate | Rates vary based on age and where you live, national mo. average $70 to as high as $300 in 2024******* |
Medical Underwriting | None | You can’t be turned down or charged more because of a health condition during initial open enrollment | Applies only if you miss your initial open enrollment period and do not qualify for a special enrollment******** |
*Also covers skilled nursing facility and foreign travel. Medigap cannot be purchased if you have Medicare Advantage. The majority of Medigap plans do not cover the Part B deductible of your Original Medicare, and per Medicare, Plans that do cover the Part B deductible (F & C) cannot be offered to new beneficiaries enrolling in Medicare.
** For Medicare Part A there is no coinsurance until you have reached your 60th day of hospitalization in each benefit period. Then you pay $408 per day until the 90th day. If you are in the hospital longer than 90 days, you can pay the full bill yourself or use your lifetime reserve days at $816 per day (up to 60 days in a lifetime).
*** Medicare allows up to $545 maximum deductible in 2024 for Prescription Drug coverage, however, half of all Medicare plans have a much smaller or ZERO deductibles for Part D. Keep in mind, these plans may have higher premiums as a trade-off.
****Unlike Original Medicare that has no maximum out-of-pocket (MOOP), the good thing about Medicare Advantage is you pay nothing for covered healthcare once you hit your annual MOOP. While some MA plans (about 20%) set the MOOP at the maximum allowed by Medicare at $8,850, many other carriers choose to have a much lower or no MOOP.
*****You will need to enroll in a separate Medicare Part D drug plan. To see Part D premiums, copays, deductibles for 2024, please visit our Part D Premiums page.
******To see Medicare premiums, copays, deductibles or 2024, please visit our Medicare premiums page.
*******To see Medigap plans, premiums, copays and deductibles, please visit our Medicare Supplement page.
********You are entitled to the lowest possible rate if you act during the initial open enrollment period. After that, unless you qualify for special enrollment, you will have to go through underwriting and may not get the best rate.
Disclaimers:
While Medicare premiums are the same in many states across the US, rates can and do vary in other states. The content above represents national averages, and some parts were retrieved from Medicare.gov.
Charline Covington-Plerqui and PTI Consulting Services are not part of the Federal Government Medicare System. The content in this post has not been reviewed or approved by Medicare.
Becoming Eligible for Medicare
To sign up for original Medicare Parts A & B, along with Part D, most people will have an Initial Enrollment Period which is a 7 month period around the time they turn age 65. This period begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
Once your Initial Enrollment Period is over, if you wish to change or purchase Advantage or Part D Plans, you must act during the open enrollment period.
NOTICE: Once you are eligible for Medicare, do not wait to enroll in a Medicare Part D Plan or you could end up paying a penalty every month.
SPECIAL ENROLLMENT – OTHER TIMES YOU MAY ENROLL
Once enrolled in Medicare, if you wish to change or purchase Medicare plans you must act during the open enrollment period.
When open enrollment is closed, there are special circumstances in which one may qualify to enroll outside of the enrollment period. Listed below are the qualifying events:
- You are turning 65
- You move to a new area that is not in your current plan’s service area
- Recently moved back to the US
- You lose your current coverage (either Group or Medicaid)
- You now need a SNP (Special Needs Plan) or you no longer need a SNP
Medicare
Open Enrollment
October 15th through December 7th every year.
A Helpful Checklist for New Medicare Recipients
Turning 65? Navigating healthcare through Medicare is not as simple as receiving it through your employer. Here’s a checklist to help make the daunting transition a little easier.
- Review your health insurance needs, taking in consideration medications and regular doctor visits, and any procedures you know you will need.
- See if your current providers accept Medicare.
- Learn the basics of Medicare to find out what Medicare covers. Visit our Medicare Premiums page, or our Medicare & You page to help you get a better understanding of Medicare.
- Talk to a Medicare Professional to help you research the cost of Medicare Advantage, Part D and Medigap Plans in your area and help you decide which is better for your needs.
- Ask your advisor if you qualify for additional benefits or getting help with Medicare costs.
Enrolling in Medicare
You need to enroll in original Medicare (Parts A & B) before you can sign up for a Medicare Advantage or Supplement plan.
To enroll, you will be required to provide proof of your eligibility. Some acceptable documents are birth certificate, proof citizenship if not born in the US, W-2 or tax forms, and or military records.
Follow this link to apply online or call your local Social Security office. Here you can enroll, create your Medicare account, track your Medicare information such as bills, claims, health information and more, as well as print your Medicare card.
Medicare Works For You and Your Health Through the ACA
Reduced prescription drug costs:
In the past when Medicare recipients entered the coverage gap known as the “Donut Hole,” they were responsible for 100% of their prescription costs. The ACA provided discounts and subsidies that reduced those costs by half, and currently, in 2021, the donut hole officially closed for all drugs. In other words, when Medicare recipients enter the coverage gap, they are now responsible for only 25% of the cost of their drugs.
Adds wellness and preventative benefits into Medicare Part B with no additional costs.
Get over a dozen FREE preventative screenings and other wellness benefits that include mammograms, colorectal screenings, heart health, free vaccines and flu shots, addiction programs, mental health services, nutrition assistance and more.
Improves Medicare Advantage
The restructuring of payments to Medicare Advantage, along with bonuses given to plans with higher quality ratings, has forced the plans to be more efficient, which lowers costs for Medicare recipients, while improving quality of care, which probably explains why currently more than a third of Medicare recipients opt for Medicare Advantage vs. original Medicare.