Medicare Options Defined
Before you dive into plan details, it’s good to have a basic understanding of Medicare in general. On this page, you’ll find definitions of Original Medicare, Medicare Supplement Plans, Medicare Advantage Plans and Prescription Drug Plans. You can also access a complete description of all the options available to Medicare eligibles at www.medicare.gov.
To learn more about the Medicare plan options available at SummaCare, click here.
There are four parts to Original Medicare.
Part A: This covers hospital bills for inpatient stays as well as things like home healthcare, hospice or nursing care. There is no premium associated with Part A.
Part B: This covers doctor, outpatient hospital, diagnostic tests, ambulance, durable medical equipment and other home health care services that are not covered under Part A. There is a premium for Part B and this premium changes every year. Typically this premium is automatically deducted from your Social Security check.
Part C: This is for those who are enrolled in a Medicare Advantage Plan.
Part D: This is the voluntary prescription drug benefit program that went into effect in 2006. Part D gives all Medicare beneficiaries the option to purchase prescription drug coverage from the company of their choice.
When you become 65 and you do not enroll in any other type of plan, you will have Original Medicare coverage. Original Medicare coverage by itself does not include prescription drug coverage.
Medicare Advantage Plan
Medicare Advantage (MA) plans “take the place of” your Original Medicare coverage. In other words, when you join an MA plan, you become a member of that plan and no longer need to use your red, white and blue Original Medicare card. You still must pay your Medicare Part B premium, however, your MA plan becomes your primary insurer.
These types of plans typically offer cost effective benefits at higher coverage levels that Original Medicare. In addition, many offer prescription drug coverage along with medical coverage for one monthly premium.
To enroll in this type of plan, as with a Medicare Supplement plan, you must physically enroll by contacting a plan and completing the appropriate paperwork. You cannot or will not be automatically enrolled in this type of plan once you become eligible for Medicare.
Prescription Drug Plan
These types of plans offer coverage for prescription drugs only. To enroll in this type of plan, as with a Medicare Supplement plan, you must physically enroll by contacting a plan and completing the appropriate paperwork. You cannot or will not be automatically enrolled in this type of plan once you become eligible for Medicare.
For a complete description of the options that are available to those eligible for Medicare, please visit www.medicare.gov.
Medicare Supplement or Medi-Gap Plan
Medicare Supplement plans offer coverage for where Original Medicare “leaves off.” For example, Original Medicare will cover 80% of a hospital stay. You are responsible for the remaining 20%. If you enroll in a Medicare Supplement plan, this plan would cover that remaining 20% - thus “supplementing” your Original Medicare coverage.
Medicare supplement plans typically do not cover prescription drugs. To have this coverage you must enroll in a separate drug plan.
To enroll in this type of plan, you must physically enroll by contacting a plan and completing the appropriate paperwork. Unlike Original Medicare, you cannot or will not be automatically enrolled in this type of plan once you become eligible for Medicare.